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NPI Code Detail

MEDICARE: AIMEE NICOLE PORTILLO

MEDICARE: AIMEE NICOLE 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
1106S00000XBehavior TechnicianRBT-17-41036TX
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1790293918
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIMEE NICOLE PORTILLO
Provider Business Mailing Address
First Line : 2300 WOLF RANCH PKWY APT 1207
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-7287
Country : US
Telephone Number : 512-968-5667
Fax Number :
Provider Business Practice Location Address
First Line : 2105 E PARK ST
Second Line :
City : CEDAR PARK
State : TX
Zip : 78613-4598
Country : US
Telephone Number : 512-588-1362
Fax Number : 512-792-4834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2018
Last Update Date : 05/18/2022

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Directions to “ AIMEE NICOLE PORTILLO ” Practice Location

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