Individual
AMANDA RAQUEL PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFTI
Contact information
Practice address
1234 EMPIRE ST, SUITE 2300, FAIRFIELD, CA 94533-5711
(707) 384-7303
(707) 247-4233
Mailing address
1234 EMPIRE ST, SUITE 2300, FAIRFIELD, CA 94533-5711
(707) 514-3764
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
95665
CA
Other
Enumeration date
10/21/2016
Last updated
10/27/2016
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