| Orlando Portal Md Inc | |
|
13150 Vail Ridge Dr Riverview FL 33579-7187 | |
| (813) 374-8883 | |
| (813) 443-8361 |
| Full Name | Orlando Portal Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 13150 Vail Ridge Dr, Riverview, Florida |
| Authorized Official Name and Position | Orlando Portal (OWNER & PRESIDENT) |
| Authorized Official Contact | 8133748883 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orlando Portal Md Inc Po Box 3695 Apollo Beach FL 33572-1010 Ph: (813) 374-8883 | Orlando Portal Md Inc 13150 Vail Ridge Dr Riverview FL 33579-7187 Ph: (813) 374-8883 |
| NPI Number | 1346651650 |
|---|---|
| Provider Enumeration Date | 05/08/2014 |
| Last Update Date | 05/07/2024 |
| Medicare PECOS PAC ID | 8123245941 |
|---|---|
| Medicare Enrollment ID | O20140818002602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346651650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME100005 (Florida) | Primary |
| Provider Name | Orlando Portal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366626111 PECOS PAC ID: 4587749932 Enrollment ID: I20080310000085 |
| Provider Name | Jeannette Velazquez-gomez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851860670 PECOS PAC ID: 8527301159 Enrollment ID: I20190522000193 |
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