Provider Demographics
NPI:1386527711
Name:PORTILLO, STEVEN ANDREW
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANDREW
Last Name:PORTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-9636
Mailing Address - Country:US
Mailing Address - Phone:505-901-9233
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DRIVER STE 102
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4903
Practice Address - Country:US
Practice Address - Phone:505-983-8225
Practice Address - Fax:505-930-5426
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical