Provider Demographics
NPI:1912742032
Name:ALVARADO-PORTILLO, BEN (NP)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:ALVARADO-PORTILLO
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:288 ATLANTIC RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1351
Mailing Address - Country:US
Mailing Address - Phone:915-873-5164
Mailing Address - Fax:
Practice Address - Street 1:6955 N MESA ST STE 200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:833-339-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154474363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology