MAURICIO PORTILLO

SHREVEPORT, LA
NPI1871267013
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2021-08-02
Last Update Date2021-08-02
Business Address
MAURICIO PORTILLO
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-626-0434
Mailing Address
MAURICIO PORTILLO
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-626-0434
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