Individual
JESSICA PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12611 BROOKVALE DR, HOUSTON, TX 77038-2006
(832) 329-5680
Mailing address
PO BOX 940003, HOUSTON, TX 77094-7003
(832) 329-5680
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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