Individual
JUAN ANTONIO PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 216-2727
Mailing address
PO BOX 28164, SANTA FE, NM 87592-8164
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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