Individual
BENJAMIN PORTILLO-DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
555 N ARLINGTON AVE, RENO, NV 89503-4723
(775) 786-3040
Mailing address
555 N ARLINGTON AVE, RENO, NV 89503-4723
(775) 786-3040
(775) 786-1887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2707
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15653680
CAQH
—
05
—
250021350
—
NV
Enumeration date
05/13/2021
Last updated
02/14/2023
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