Provider Demographics
NPI:1821971888
Name:EL PORTALITO
Entity type:Organization
Organization Name:EL PORTALITO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-647-9904
Mailing Address - Street 1:3934 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6444
Mailing Address - Country:US
Mailing Address - Phone:209-647-9904
Mailing Address - Fax:
Practice Address - Street 1:1149 E MARKET ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-5525
Practice Address - Country:US
Practice Address - Phone:209-647-9904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals