Individual
ALEXIS ADRIAN PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11601 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87111-2660
(505) 609-7896
Mailing address
1009 FLEMING RD, BLOOMFIELD, NM 87413-6544
(505) 609-7896
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2022-0133
NM
363AM0700X
Medical Physician Assistant
PA2022-0133
NM
Other
Enumeration date
03/15/2022
Last updated
04/26/2023
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