Most Relevant Information
Provider Data
| NPI Number: | 1003374190 |
| Provider Name: | MONICA PORTILLO |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/07/2019 |
| Last Updated: | 03/07/2019 |
Provider Practice Location
13568 COUNTY ROAD 2241
TYLER
TX
757076616
Practice Location Phone/Fax
| Phone: | 9038053123 |
| Fax: |
Provider Mailing Location
13568 COUNTY ROAD 2241
TYLER
TX
757076616
Provider Mailing Phone/Fax
| Phone: | 9038053123 |
| Fax: |