Provider Demographics
NPI:1528954955
Name:PORTILLO, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 RIVER DR S APT 28
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51109-4303
Mailing Address - Country:US
Mailing Address - Phone:712-251-3183
Mailing Address - Fax:
Practice Address - Street 1:1600 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776
Practice Address - Country:US
Practice Address - Phone:402-494-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care