MEDICARE: YESENIA PORTILLO NP

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	363LA2100X	Acute Care Nurse Practitioner	95021315	CA

General Provider Information

NPI Number	:	1770280182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESENIA PORTILLO NP

Provider Business Mailing Address
First Line	:	4477 W 118TH ST STE 200
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2257
Country	:	US
Telephone Number	:	310-675-4440
Fax Number	:	310-675-5816

Provider Business Practice Location Address
First Line	:	4477 W 118TH ST STE 200
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2257
Country	:	US
Telephone Number	:	310-675-4440
Fax Number	:	310-675-5816

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

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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Directions to “ YESENIA PORTILLO NP” Practice Location

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