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Individual
MARTHA MANTILLA DONOVAN
Active
Individual
MARTHA MANTILLA DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A53911
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A539110
BLUE SHIELD
CA
05
—
00A539112
—
CA
Enumeration date
07/27/2006
Last updated
10/07/2014
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