Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | S8098 | TX |
N | 208000000X | Pediatrician | 265871 | MA |
NPI | 1144563735 |
---|---|
Provider Name | Elyse Nicole Portillo |
First Address | Houston, TX 77030-2374 |
Second Address | Houston, TX 77030-2374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 24/08/2020 |