| Juan A Mantilla Md Pa | |
|
11400 N Kendall Dr Ste 204 Miami FL 33176-1029 | |
| (305) 279-2222 | |
| (305) 501-2031 |
| Full Name | Juan A Mantilla Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 11400 N Kendall Dr Ste 204, Miami, Florida |
| Authorized Official Name and Position | Juan Alberto Mantilla (PRESIDENT) |
| Authorized Official Contact | 3052794222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Juan A Mantilla Md Pa 11400 N Kendall Dr Ste 204 Miami FL 33176-1029 Ph: (305) 279-2222 | Juan A Mantilla Md Pa 11400 N Kendall Dr Ste 204 Miami FL 33176-1029 Ph: (305) 279-2222 |
| NPI Number | 1962732388 |
|---|---|
| Provider Enumeration Date | 01/07/2010 |
| Last Update Date | 06/29/2021 |
| Medicare PECOS PAC ID | 8921287780 |
|---|---|
| Medicare Enrollment ID | O20110125001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962732388 | NPI | - | NPPES |
| 266223000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME77038 (Florida) | Primary |
| Provider Name | Juan A Mantilla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699715292 PECOS PAC ID: 8820011992 Enrollment ID: I20060104000836 |
| Provider Name | Humberto J Jimenez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417278227 PECOS PAC ID: 5597945246 Enrollment ID: I20110211000824 |
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