Provider Demographics
NPI:1497508279
Name:PORTILLA'S TRANSPORTATION
Entity Type:Organization
Organization Name:PORTILLA'S TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:JOHNSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-736-8269
Mailing Address - Street 1:100 S CLINTON AVE FL 24
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1846
Mailing Address - Country:US
Mailing Address - Phone:585-736-8269
Mailing Address - Fax:
Practice Address - Street 1:100 S CLINTON AVE FL 24
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1846
Practice Address - Country:US
Practice Address - Phone:585-736-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)