Provider Demographics
NPI:1235919424
Name:PORTILLO GARCIA, DINA ROSIO (LMFT)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:ROSIO
Last Name:PORTILLO GARCIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:R
Other - Last Name:PORTILLO GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1844 W 11TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3586
Mailing Address - Country:US
Mailing Address - Phone:323-449-3092
Mailing Address - Fax:
Practice Address - Street 1:1401 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-6204
Practice Address - Country:US
Practice Address - Phone:626-252-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT141247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist