MANUEL ENRIQUE PORTALATIN DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

ACTIVE

Business

Title

First Name

MANUEL

Middle

ENRIQUE

Last Name

PORTALATIN

Business Name

MANUEL ENRIQUE PORTALATIN DO

Original Issue Date

04/28/2021

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

MAYWOOD

State

Zip

60153

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023