Portilla Medical Group LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PORTILLA MEDICAL GROUP LLC

Practice address

330 SW 27TH Ave
Ste 302
Miami, FL 33135-2961

Phone

(305) 631-1220

Fax

(305) 631-1251

NPI assigned

Jun 18, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marianela De la Portilla, M.D,

Title

President/Medical Director

Phone

(305) 631-1220

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1124467717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SW 27TH AVE",
            "address_2": "STE 302",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331352961",
            "telephone_number": "305-631-1220",
            "fax_number": "305-631-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 SW 27TH AVE",
            "address_2": "STE 302",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331352961",
            "telephone_number": "305-631-1220",
            "fax_number": "305-631-1251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTILLA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-18",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "DE LA PORTILLA",
        "authorized_official_first_name": "MARIANELA",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "305-631-1220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D,"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010921800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "HU244A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cashmere Nicole Porter
• Dulce M. Porter, OT
• Kadijah Falah Porter, MD
• Dalia R. Portero, PHD
• Portilla Diagnostic Group LLC
• Lilivet Portilla Perez, RBT
• Alicia M Portillo Velasquez
• Cimelitza Portillo, LMHC
• Georgina Yamila Portillo
• Jerlin Estefani Portillo

• Multi-Specialty Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.