| Doctor Name: | MARIANELA DE LA PORTILLA |
| NPI Number: | 1104875178 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | ME62522 |
| Business Practice Address: | 330 Sw 27th Ave Suite 302 Miami, FL - 331352961 |
| Business Phone Number: | 3056311220 |
| Business Fax Number: | 3056311251 |
| Mailing Address: | 330 Sw 27th Ave, Suite 302 MIAMI |
| State: | FL |
| Postal Code: | 331352961 |
| Phone Number: | 3056311220 |
| Fax Number: | 3056311251 |
| NPI Enumeration Date: | 05/08/2006 |
| NPI Last Update Date: | 02/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME62522 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |