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General NPI Number Information
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NPI Number | 1144804691
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Entity Type | Individual
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Provider Name | GEORGINA AGUILAR-PORTILLO MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 951-486-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 CONSTITUTION BLVD BLDG 400, THIRD FLOOR
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City | SALINAS
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State | CA
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Zip | 93906-3100
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Country | US
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Telephone | 831-755-4123
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A184608
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License Number State | CA
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