Daley Cie Portillo, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA21917 Issued in CA

Practice address

9685 Via Excelencia
San Diego, CA 92126-7500

Phone

(888) 627-9747

NPI assigned

Oct 11, 2011

Sex

Female

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

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: daley.dodd.p2@direct.mpmccorp.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: daley.dodd.p6@direct.mpmccorp.nextgenshare.com

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.

• Allsafe Medical Group Inc.

  • Obstetrics & Gynecology Physician
  • Downey, CA
  • NPI 1457596371
  Medicare reassignment
• Northeast Community Clinic

  dba Diabetes & Endocrinology Specialty Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1063927564
  NPD
• Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
  • NPI 1275226334
  NPD
• Pacific Perinatal Institute

  • Maternal & Fetal Medicine Physician
  • Colton, CA
  • NPI 1942692777
  NPD (past)

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1619251543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 S AVENUE 53",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900424508",
            "telephone_number": "641-781-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9685 VIA EXCELENCIA",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921267500",
            "telephone_number": "888-627-9747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5420 N Figueroa St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900424118",
            "country_code": "US",
            "telephone_number": "626-457-5515",
            "fax_number": "626-457-6923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTILLO",
        "first_name": "DALEY",
        "middle_name": "CIE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-11",
        "last_updated": "2022-05-11",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauryn Dawn Porterfield
• Brenda Jacqueline Portillo Salazar, RN
• Alyson Erin Portillo
• Ana Christina Portillo
• Ashley America Portillo
• Elisa Portillo
• Leslie E Portillo
• Eva Donise Portley-Sanders
• Rebecca Dawn Portnoy
• Ivan Torrance Porto, PHARMD

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.