Individual
MRS. GIA DANIELLA PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7 VACQUERO LN, TULAROSA, NM 88352-9318
(575) 430-0246
Mailing address
7 VACQUERO LN, TULAROSA, NM 88352-9318
(575) 430-0246
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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