Individual
MIDORI PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4410 NE 80TH AVE, PORTLAND, OR 97218-4216
(408) 250-4744
Mailing address
4410 NE 80TH AVE, PORTLAND, OR 97218-4216
(408) 250-4744
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/14/2019
Last updated
02/14/2019
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