Basic Information
| Provider Information | |||||||||
| NPI: | 1164974333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ PORTILLO | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | SILVESTRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4193 S RICHFIELD WAY | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800133227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208797880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4141 E DICKENSON PL # 80222 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802226012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035046500 | ||||||||
| FaxNumber: | 3037585793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2016 | ||||||||
| LastUpdateDate: | 11/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.