Provider Demographics
NPI:1083243661
Name:PORTILLO, DONNA BELLA LAUREL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA BELLA
Middle Name:LAUREL
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DONNA BELLA
Other - Middle Name:LAUREL
Other - Last Name:TRANSFIGURACION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:18312 BASSANO AVE
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660
Mailing Address - Country:US
Mailing Address - Phone:737-600-2794
Mailing Address - Fax:
Practice Address - Street 1:12221 N MOPAC EXPWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-901-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist