Individual
JAKE PORTILLO
Active
Individual
JAKE PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101285892
VA
208100000X
Physical Medicine & Rehabilitation Physician
125080756
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2021
Last updated
10/22/2025
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