Most Relevant Information
Provider Data
| NPI Number: | 1003659699 |
| Provider Name: | CARMEN PORTILLO |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/13/2024 |
| Last Updated: | 06/13/2024 |
Provider Practice Location
3847 S 98TH EAST AVE
TULSA
OK
741462424
Practice Location Phone/Fax
| Phone: | 9186999373 |
| Fax: |
Provider Mailing Location
3847 S 98TH EAST AVE
TULSA
OK
741462424
Provider Mailing Phone/Fax
| Phone: | 9186999373 |
| Fax: |