Provider Demographics
NPI:1225046303
Name:PORTELLA, JOSILU (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:JOSILU
Middle Name:
Last Name:PORTELLA
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:3620 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1756
Mailing Address - Country:US
Mailing Address - Phone:703-359-8640
Mailing Address - Fax:703-591-6105
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 406
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-359-8640
Practice Address - Fax:703-591-6105
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical