Individual provider Active NPI

Reina Paola Portobanco, COTA/L

  • Occupational Therapy Assistant
  • Miami Gardens, FL
National Provider Identifier
1124562137
Registry record updated Dec 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA15606 Issued in FL
Practice address
18713 NW 46TH Ave
Miami Gardens, FL 33055-2655
Phone
(786) 499-4189
NPI assigned
Dec 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA15606 FL Primary

Addresses

Primary practice location

18713 NW 46TH Ave
Miami Gardens, FL 33055-2655

Mailing address

18713 NW 46TH Ave
Miami Gardens, FL 33055-2655
Phone (786) 499-4189

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA15606FLMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1124562137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18713 NW 46TH AVE",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330552655",
            "telephone_number": "786-499-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18713 NW 46TH AVE",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330552655",
            "telephone_number": "786-499-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTOBANCO",
        "first_name": "REINA",
        "middle_name": "PAOLA",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-09",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA15606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; 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.