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NPI Code Detail

MEDICARE: MR. EDGAR ESTEBAN PORTILLO FNP-BC

MEDICARE: MR. EDGAR ESTEBAN PORTILLO FNP-BC
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
1363LF0000XFamily Nurse PractitionerAP3259AZ

General Provider Information

NPI Number : 1467690701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDGAR ESTEBAN PORTILLO FNP-BC
Provider Business Mailing Address
First Line : PO BOX 188
Second Line :
City : MARANA
State : AZ
Zip : 85653-0188
Country : US
Telephone Number : 520-682-4111
Fax Number : 520-616-1442
Provider Business Practice Location Address
First Line : 3690 S PARK AVE STE 805
Second Line :
City : TUCSON
State : AZ
Zip : 85713-5042
Country : US
Telephone Number : 520-616-6760
Fax Number : 520-616-6799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2009
Last Update Date : 09/04/2025

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Directions to “ MR. EDGAR ESTEBAN PORTILLO FNP-BC” Practice Location

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