Active NPI
Eli John Portugues
- Pharmacist
- Covina, CA
National Provider Identifier
1194327106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 83854
- Practice address
- 206 N Azusa Ave
Covina, CA 91722-3606 - Phone
- (626) 331-9907
- NPI assigned
- Nov 13, 2020
- Last updated
- Nov 13, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 83854 | CA | Primary |
Addresses
Primary practice location
206 N Azusa Ave
Covina, CA 91722-3606
Mailing address
206 N Azusa Ave
Covina, CA 91722-3606
Phone (626) 331-9907
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
| License | State | Type | Specialty |
|---|---|---|---|
| 83854 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS LLC | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605225600000",
"number": "1194327106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 N AZUSA AVE",
"city": "COVINA",
"state": "CA",
"postal_code": "917223606",
"telephone_number": "626-331-9907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 N AZUSA AVE",
"city": "COVINA",
"state": "CA",
"postal_code": "917223606",
"telephone_number": "626-331-9907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTUGUES",
"first_name": "ELI",
"middle_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-13",
"last_updated": "2020-11-13",
"certification_date": "2020-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "83854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.