Luis A. Portal-Queirolo, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY19146 Issued in CA

Practice address

3990 Westerly PL
Suite 160
Newport Beach, CA 92660-2310

Phone

(714) 488-9869

Fax

(949) 955-1216

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351123200000",
    "number": "1629169354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 WESTERLY PL STE 160",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602345",
            "telephone_number": "714-488-9869",
            "fax_number": "949-955-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 WESTERLY PL",
            "address_2": "SUITE 160",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602310",
            "telephone_number": "714-488-9869",
            "fax_number": "949-955-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTAL-QUEIROLO",
        "first_name": "LUIS",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2012-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian-Jeff Mistica Pontiga
• Jessica Ann Poole
• Lisa Louise Popper, LMFT
• Poppy Life Care Foundation, Inc.
• Poppy Life Care Inc (Poppy Life Care)
• Brian J Porteous, D.C.
• Naomi Y Porter, PA-C
• David Porzio, M.D.
• Posc of Orange, LLC
• Post-Acute Care Physicians, Inc.

• Clinical Psychologist in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.