MEDICARE: DARIA PORTILLO MFT

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
1	106H00000X	Marriage & Family Therapist	45356	CA

General Provider Information

NPI Number	:	1538303722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIA PORTILLO MFT

Provider Business Mailing Address
First Line	:	1139 N BRAND BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3012
Country	:	US
Telephone Number	:	415-318-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1139 N BRAND BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3012
Country	:	US
Telephone Number	:	415-318-6150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	03/31/2016

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Directions to “ DARIA PORTILLO MFT” Practice Location

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