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General NPI Number Information
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NPI Number | 1023486958
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Entity Type | Individual
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Provider Name | PERRINE PORTILLO PSY.D
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Gender | Female
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 10368 DONNER PASS RD
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City | TRUCKEE
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State | CA
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Zip | 96161-0427
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Country | US
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Telephone | 530-536-0663
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Fax |
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Provider Business Mailing Address
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Address Line | 11260 DONNER PASS RD. STE C1 PMB 635
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City | TRUCKEE
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State | CA
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Zip | 96161
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Country | US
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Telephone | 530-536-0663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY31525
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License Number State | CA
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