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General NPI Number Information
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NPI Number | 1467690701
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Entity Type | Individual
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Provider Name | EDGAR ESTEBAN PORTILLO FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2009
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 3690 S PARK AVE STE 805
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City | TUCSON
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State | AZ
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Zip | 85713-5042
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Country | US
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Telephone | 520-616-6760
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Fax | 520-616-6799
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | MARANA
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State | AZ
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Zip | 85653-0188
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Country | US
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Telephone | 520-682-4111
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Fax | 520-616-1442
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP3259
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License Number State | AZ
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