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1871267013
MAURICIO PORTILLO
SHREVEPORT, LA
NPI
1871267013
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-08-02
Last Update Date
2021-08-02
Business Address
MAURICIO PORTILLO
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-626-0434
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Mailing Address
MAURICIO PORTILLO
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-626-0434
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