Individual
LORI MARIE DE LA PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
462 QUEEN ST # 303, SOUTHINGTON, CT 06489-1801
(305) 281-6686
Mailing address
462 QUEEN ST, STE 303, SOUTHINGTON, CT 06489-1801
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
63628
CT
Other
Enumeration date
04/11/2013
Last updated
01/24/2020
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