Active NPI
Jennie Isaura Portillo
- Counselor
- Anaheim, CA
National Provider Identifier
1255067658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 13621
- Practice address
- 222 S Harbor Blvd Ste 400
Anaheim, CA 92805-3743 - Phone
- (714) 517-6300
- Fax
- (714) 517-6306
- NPI assigned
- Jul 27, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 13621 | CA | Primary |
Addresses
Primary practice location
222 S Harbor Blvd Ste 400
Anaheim, CA 92805-3743
Mailing address
2035 E Ball Rd
Anaheim, CA 92806-5159
Phone (714) 517-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13621 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Orange | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adult Mental Health Clinic/Center
- Anaheim, CA
- NPI 1245377423
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772150400000",
"number": "1255067658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2035 E BALL RD",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928065159",
"telephone_number": "714-517-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 S HARBOR BLVD STE 400",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928053743",
"telephone_number": "714-517-6300",
"fax_number": "714-517-6306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTILLO",
"first_name": "JENNIE",
"middle_name": "ISAURA",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-27",
"last_updated": "2026-02-27",
"certification_date": "2026-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "13621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.