Provider Demographics
NPI:1053190082
Name:PORTUONDO SAO, BEATRIZ ILEANA (PS47405)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ILEANA
Last Name:PORTUONDO SAO
Suffix:
Gender:F
Credentials:PS47405
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 SW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7353
Mailing Address - Country:US
Mailing Address - Phone:786-587-3341
Mailing Address - Fax:305-424-7324
Practice Address - Street 1:13780 SW 26TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6302
Practice Address - Country:US
Practice Address - Phone:305-424-7212
Practice Address - Fax:305-424-7324
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist