Individual
JASON PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25825 VERMONT AVE, HARBOR CITY, CA 90710-3518
(310) 257-6413
(310) 517-3094
Mailing address
25825 VERMONT AVE, HARBOR CITY, CA 90710-3518
(310) 257-6413
(310) 517-3094
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
A125714
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114003
SID # 114003
CA
Enumeration date
01/25/2012
Last updated
11/04/2021
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