Roger Antonio Portillo

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW87707 Issued in CA

Practice address

405 N 19TH St
Montebello, CA 90640-3942

Phone

(323) 788-6298

NPI assigned

Jun 24, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1487940755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11741 TELEGRAPH RD",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906703681",
            "telephone_number": "562-949-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 N 19TH ST",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403942",
            "telephone_number": "323-788-6298"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11741 Telegraph Rd",
            "address_purpose": "LOCATION",
            "city": "Santa Fe Springs",
            "state": "CA",
            "postal_code": "906703681",
            "country_code": "US",
            "telephone_number": "562-949-8455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTILLO",
        "first_name": "ROGER",
        "middle_name": "ANTONIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-24",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW87707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PO Zan Chen Medical Corporation
• Poimen Health Care, Inc
• Pokagon Dialysis, LLC
• Sarah Ponce, RN MSN CNS NP
• Pooyan Nasibi DDS Inc
• Prescott C. Rasmussen, M.D.
• Sairwaa Tandee Prevost, M.D.
• Procare Home Health Agency Inc
• Rong Pu, NP
• Yu Qin Qi, L.AC.

• Clinical Social Worker in Montebello, CA
• Providers in Montebello, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.