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General NPI Number Information
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NPI Number | 1104788835
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Entity Type | Individual
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Provider Name | KATY J PORTILLO
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 413 S SUNSET ST APT A
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City | RIDGECREST
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State | CA
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Zip | 93555-4566
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Country | US
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Telephone | 760-461-0987
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Fax |
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Provider Business Mailing Address
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Address Line | 413 S SUNSET ST APT A
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City | RIDGECREST
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State | CA
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Zip | 93555-4566
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Country | US
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Telephone | 760-461-0987
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number | E1904908
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License Number State | CA
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