Individual
ALEXANDRIA MIA PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
12 E 86TH ST, NEW YORK, NY 10028-0506
(212) 861-6660
Mailing address
16509 MAGOLIA CT, SILVER SPRING, MD 20905
(305) 479-3928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F352697-01
NY
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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