Individual
EDELMIRA PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14829 CRANBROOK AVE APT 111, HAWTHORNE, CA 90250-8415
(719) 321-4170
Mailing address
14829 CRANBROOK AVE APT 111, HAWTHORNE, CA 90250-8415
(719) 321-4170
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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