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Individual
GUILLERMO ALBERTO MANTILLA
Active
Individual
GUILLERMO ALBERTO MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
42647
TN
208M00000X
Hospitalist Physician
Primary
C159709
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512334
—
TN
01
—
4352401
BCBS
TN
05
—
7100423880
—
KY
Enumeration date
09/19/2007
Last updated
02/26/2019
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