Provider Demographics
NPI:1487948469
Name:HERNANDEZ-PORTILLO, SANDRA (LBSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:HERNANDEZ-PORTILLO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5629
Mailing Address - Country:US
Mailing Address - Phone:915-532-9434
Mailing Address - Fax:915-532-4820
Practice Address - Street 1:1511 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5629
Practice Address - Country:US
Practice Address - Phone:915-532-9434
Practice Address - Fax:915-532-4820
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker