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Individual
DIDIER PORTILLA
Active
Individual
DIDIER PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101257080
VA
207RN0300X
Nephrology Physician
R-4238
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121269001
—
AR
01
—
390004629
RAILROAD MEDICARE
AR
Enumeration date
10/13/2006
Last updated
12/23/2014
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