Individual
DALEY CIE PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
9685 VIA EXCELENCIA, SAN DIEGO, CA 92126-7500
(888) 627-9747
Mailing address
182 S AVENUE 53, LOS ANGELES, CA 90042-4508
(641) 781-1283
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA21917
CA
Other
Enumeration date
10/11/2011
Last updated
05/11/2022
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