Provider Demographics
NPI:1982431383
Name:PERDIGON PORTIELES, CARLOS J (MD, USD SPECIALIST)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:PERDIGON PORTIELES
Suffix:
Gender:M
Credentials:MD, USD SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S ROYAL POINCIANA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6087
Mailing Address - Country:US
Mailing Address - Phone:786-353-2448
Mailing Address - Fax:
Practice Address - Street 1:10 S ROYAL POINCIANA BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6087
Practice Address - Country:US
Practice Address - Phone:305-987-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
P107102471S1302X
FLHSE41403208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography