Individual
DR. DIANA PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-C, PMHNP-BC
Contact information
Practice address
330 N CAMPO ST, LAS CRUCES, NM 88001-3433
(575) 288-1336
(575) 222-4453
Mailing address
PO BOX 1731, LAS CRUCES, NM 88004-1731
(575) 288-1336
(575) 222-4453
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP-01613
NM
363LP2300X
Primary Care Nurse Practitioner
CNP-01613
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20636865
—
NM
01
—
NMA100470
MEDICARE
NM
Enumeration date
03/24/2010
Last updated
10/02/2020
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