Individual
MS. BREANNA PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1412 TAMAR LN, AUSTIN, TX 78727-3332
(512) 574-7159
Mailing address
1412 TAMAR LN, AUSTIN, TX 78727-3332
(512) 574-7159
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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