Mauricio Portillo
Mauricio Portillo is a Family Practice in Shreveport, Louisiana. Qualified in 2021, 5 years ago. Practices as a sole proprietor. Licensed in Oklahoma.
- Years since qualifying
- 5
- Licensed in
- OK
- In the registry since
- 2021
- Specialties on file
- 2
Practice location Address checks out
Shreveport, LANo coordinates on file. Search this address in Google Maps
Specialties & licences
| Family Medicine Physician (primary) | Taxonomy 207Q00000X · Licence 47345 (OK) |
|---|---|
| Student in an Organized Health Care Education/Training Program | Taxonomy 390200000X |
Record details
| NPI number | 1871267013 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | August 2, 2021 |
| Last updated in NPPES | May 29, 2026 |
| Certification date | May 29, 2026 |
Medicare enrollment
| Medicare specialty | FAMILY PRACTICE |
|---|---|
| Medical school | OTHER |
| Graduated | 2021 (5 years in practice) |
| Accepts Medicare assignment | Not indicated |
| Practice locations | 2 on file with Medicare |
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