Individual
VLADIMIR ALEXANDER PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3820 MARTIN LUTHER KING JR BLVD, LYNWOOD, CA 90262-3625
(310) 632-0415
Mailing address
14819 GRIDLEY RD, NORWALK, CA 90650-5723
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
95098347
CA
Other
Enumeration date
01/25/2019
Last updated
01/25/2019
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