Provider Demographics
NPI:1992900203
Name:PORTALATIN, CARMEN A (RPH)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:A
Last Name:PORTALATIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 CALLE TORRES CINTRON
Mailing Address - Street 2:SANTIAGO IGLESIAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4111
Mailing Address - Country:US
Mailing Address - Phone:787-707-7074
Mailing Address - Fax:
Practice Address - Street 1:1316 CALLE TORRES CINTRON
Practice Address - Street 2:SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4111
Practice Address - Country:US
Practice Address - Phone:787-707-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist