Provider Demographics
NPI:1992464747
Name:HERRERA PORTUONDO, MAGELA
Entity type:Individual
Prefix:
First Name:MAGELA
Middle Name:
Last Name:HERRERA PORTUONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2509
Mailing Address - Country:US
Mailing Address - Phone:786-477-0169
Mailing Address - Fax:
Practice Address - Street 1:3511 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2509
Practice Address - Country:US
Practice Address - Phone:786-477-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health