Individual
DIANA PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN BSN
Contact information
Practice address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
Mailing address
7 LAUREL ST APT 10, WORCESTER, MA 01608-1049
(508) 762-6023
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN2340199
MA
Other
Enumeration date
06/07/2020
Last updated
06/07/2020
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