Active NPI
Myriam Portilla, MD
- Family Medicine Physician
- Trujillo Alto, PR
National Provider Identifier
1619006053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11189
- Practice address
- BG1 Via del Bosque
Bosque del Lago Encantada
Trujillo Alto, PR 00976-6058 - Phone
- (787) 340-1717
- Fax
- (787) 725-3629
- NPI assigned
- Mar 3, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11189 | PR | Primary |
Addresses
Primary practice location
BG1 Via del Bosque
Bosque del Lago Encantada
Trujillo Alto, PR 00976-6058
Mailing address
BG1 Via del Bosque
Bosque del Lago Encantada
Trujillo Alto, PR 00976-6058
Phone (787) 340-1717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11189 | Other | PR | LIC ESTATAL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CRM Group Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401753600000",
"number": "1619006053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BG1 VIA DEL BOSQUE",
"address_2": "BOSQUE DEL LAGO ENCANTADA",
"city": "TRUJILLO ALTO",
"state": "PR",
"postal_code": "009766058",
"telephone_number": "787-340-1717",
"fax_number": "787-725-3629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BG1 VIA DEL BOSQUE",
"address_2": "BOSQUE DEL LAGO ENCANTADA",
"city": "TRUJILLO ALTO",
"state": "PR",
"postal_code": "009766058",
"telephone_number": "787-340-1717",
"fax_number": "787-725-3629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTILLA",
"first_name": "MYRIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-03",
"last_updated": "2014-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PR",
"license": "11189",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC ESTATAL",
"identifier": "11189",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Trujillo Alto, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.