Individual
ANA MARIA PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 S SOLANO DR, LAS CRUCES, NM 88001-3758
(575) 571-4710
Mailing address
3003 RONNA DR, LAS CRUCES, NM 88001-7531
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
10/07/2014
Last updated
10/07/2014
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