Gustavo de la Portilla MD PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME83614 Issued in FL

Legal business name

GUSTAVO DE LA PORTILLA MD PA

Practice address

11452 Quail Roost Dr
Miami, FL 33157-6546

Phone

(305) 255-1966

Fax

(305) 259-0147

NPI assigned

Nov 7, 2008

Organization subpart

No

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

Authorized official

Name

Gustavo De la Portilla, MD

Title

President

Phone

(305) 255-1966

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1226016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1376797027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11452 QUAIL ROOST DR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331576546",
            "telephone_number": "305-255-1966",
            "fax_number": "305-259-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11452 QUAIL ROOST DR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331576546",
            "telephone_number": "305-255-1966",
            "fax_number": "305-259-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUSTAVO DE LA PORTILLA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-07",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "DE LA PORTILLA",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-255-1966",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME83614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmed Arif Gurses
• Fernanda Gushken, MD
• Laura Lee Gust
• Michele Lynn Gust, BS PT
• Benson Gustave
• Gustavo G Leon MD PA
• Barry E Gustin, M.D.
• Cosmin G Guta, MD
• Evisa Guterman, PA-C
• Yoram Dov Gutfreund, M.D.

• General Practice Physician in Miami, FL
• Providers in Miami, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.