Jacqueline Angeles Portobanco

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA16049 Issued in FL

Practice address

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

Phone

(754) 610-0209

NPI assigned

Nov 1, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1572566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1679117691",
    "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": "754-610-0209"
        },
        {
            "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": "754-610-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTOBANCO",
        "first_name": "JACQUELINE",
        "middle_name": "ANGELES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-01",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA16049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERMINENT LICENSURE",
            "identifier": "OTA16049",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jacqueline.portobanco@gmail.com",
            "affiliation": "N",
            "endpointDescription": "e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "18713 NW 46th Ave",
            "city": "Miami Gardens",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330552655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda Sofia Pons Valdes
• Gonzalo Portal Lemock, APRN
• Julio Portal
• Yudeny D Portal, RBT
• Yaimaris Portela
• Maria Portobanco, OTR/L
• Reina Paola Portobanco, COTA/L
• Line Posada Hernandez
• Positive Behavior Services
• Maria Regla Pou, BA

• Occupational Therapy Assistant in Miami Gardens, FL
• Providers in Miami Gardens, FL by specialty
• Occupational Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.