Individual
PENELOPE MANTILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SA-C
Contact information
Practice address
10500 NW 74TH ST APT 2-102, MEDLEY, FL 33178-2400
(312) 672-2209
Mailing address
10500 NW 74TH ST APT 2-102, MEDLEY, FL 33178-2400
(312) 672-2209
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
01/14/2021
Last updated
01/14/2021
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