Individual
MICHELLE PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
636 SW 40TH TER, OKLAHOMA CITY, OK 73109-3506
(405) 992-3746
Mailing address
636 SW 40TH TER, OKLAHOMA CITY, OK 73109-3506
(405) 992-3746
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/06/2024
Last updated
11/06/2024
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