Individual
BERTA ALICIA PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
313 HILLTOP, SOCORRO, NM 87801
(505) 433-8361
Mailing address
313 HILLTOP ST, SOCORRO, NM 87801-4123
(505) 433-8361
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7410
NM
Other
Enumeration date
09/07/2012
Last updated
09/13/2012
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