Individual
AMERICA PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7281 GARDEN GROVE BLVD STE H, GARDEN GROVE, CA 92841-4212
(714) 914-0515
Mailing address
835 W STEVENS AVE APT 11, SANTA ANA, CA 92707-5033
(714) 914-0515
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90397735F13358
BENEFITS IDENTIFICATION CARD
CA
Enumeration date
04/18/2014
Last updated
04/18/2014
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