Individual
DIANA M PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
148 ENGLE ST, ENGLEWOOD, NJ 07631-2581
(201) 569-1530
(201) 569-6022
Mailing address
148 ENGLE ST, ENGLEWOOD, NJ 07631-2581
(201) 569-1530
(201) 569-6022
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA08154700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
369394027A
—
CA
Enumeration date
08/21/2006
Last updated
03/03/2010
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