# JESSICA MANTILLA MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861841348
- **Authorized official:** JESSICA P MANTILLA MD (PRESIDENT)
- **Authorized official phone:** (951) 929-6260

## Contact information

- **Practice address:** 100 S RAYMOND AVE, ALHAMBRA, CA 91801-3166
- **Practice address phone:** (951) 929-6260
- **Practice address fax:** (951) 765-2855
- **Mailing address:** PO BOX 788, HEMET, CA 92546-0788
- **Mailing address phone:** (951) 929-6260
- **Mailing address fax:** (951) 765-2855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | A110850 | CA | Yes |

## Other

- **Enumeration date:** 06/06/2016
- **Last updated:** 06/06/2016