Provider Demographics
NPI:1174272934
Name:FAVELA-PORTILLO, VALERIE CRYSTAL (DPT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:CRYSTAL
Last Name:FAVELA-PORTILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 N LEE TREVINO DR STE 700
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4129
Mailing Address - Country:US
Mailing Address - Phone:915-593-3787
Mailing Address - Fax:915-590-9165
Practice Address - Street 1:1891 N LEE TREVINO DR STE 700
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4129
Practice Address - Country:US
Practice Address - Phone:915-593-3787
Practice Address - Fax:915-590-9165
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist