Provider Demographics
NPI:1134685282
Name:PORTILLO, CESAR ROMARIO (ATC)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:ROMARIO
Last Name:PORTILLO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-3831
Mailing Address - Country:US
Mailing Address - Phone:409-877-2413
Mailing Address - Fax:
Practice Address - Street 1:3915 AVENUE K
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-3831
Practice Address - Country:US
Practice Address - Phone:409-877-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer