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NPI Code Detail

MEDICARE: STEVEN ANDREW PORTILLO

MEDICARE: STEVEN ANDREW PORTILLO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1386527711
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN ANDREW PORTILLO
Provider Business Mailing Address
First Line : 636 SUNSET DR
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-9636
Country : US
Telephone Number : 505-901-9233
Fax Number :
Provider Business Practice Location Address
First Line : 404 HUNTER ST
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2655
Country : US
Telephone Number : 505-753-4123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2025
Last Update Date : 01/13/2026

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Directions to “ STEVEN ANDREW PORTILLO ” Practice Location

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