Abimelec Portalatin Perez

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3428 Issued in PR

Practice address

Carr 459 KM 1.8 Int
Aguadilla, PR 00603

Phone

(787) 718-2284

NPI assigned

May 31, 2022

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 PR

Eligible to order & refer

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

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": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1689313587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "SAN ANTONIO",
            "state": "PR",
            "postal_code": "006900310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 459 KM 1.8 INT",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "00603",
            "telephone_number": "787-718-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTALATIN PEREZ",
        "first_name": "ABIMELEC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "3428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wanda I Polanco, RN
• Policlinica Diaz Arana
• Policlinica Dra. Janice Sanchez C.S.P.
• Pon Seguro
• Ponce Medical School Foundation
• Loida M Portalatin Perez, PHARMD
• Edwin Portalatin, MD
• Edgar Allan Pou Acevedo, MD
• Prevention Medical Services PSC
• Primary & Occupational Medical Office Inc

• General Practice Dentistry in Aguadilla, PR
• Providers in Aguadilla, PR by specialty
• General Practice Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; 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.