Provider Demographics
NPI:1508400987
Name:PORTILLO, DANILA YESENIA (FNP)
Entity Type:Individual
Prefix:
First Name:DANILA
Middle Name:YESENIA
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4566 FLORENCE AVE SUITE 5
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4346
Mailing Address - Country:US
Mailing Address - Phone:323-771-4661
Mailing Address - Fax:
Practice Address - Street 1:4566 FLORENCE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-4346
Practice Address - Country:US
Practice Address - Phone:323-771-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty