Provider Demographics
NPI:1164755716
Name:PORTILLO, CLAUDIA PAULINA (PAC)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:PAULINA
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ADVENTIST PHYSICIAN SERVICES INC
Mailing Address - Street 2:P.O BOX 64742
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-0001
Mailing Address - Country:US
Mailing Address - Phone:301-315-3171
Mailing Address - Fax:240-826-7040
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-826-7072
Practice Address - Fax:240-826-7040
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002840363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical