Healthcare Provider Details

I. General information

NPI: 1144804691
Provider Name (Legal Business Name): GEORGINA AGUILAR-PORTILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD BLDG 400, THIRD FLOOR
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4000
  • Fax:
Mailing address:
  • Phone: 831-755-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA184608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: