Individual
ISRAEL JUAN MANTECON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1723 LUCERNE TER STE 100, ORLANDO, FL 32806-2916
(407) 738-4200
Mailing address
1723 LUCERNE TER STE 100, ORLANDO, FL 32806-2916
(407) 738-4200
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME54748
FL
207UN0901X
Nuclear Cardiology Physician
ME54748
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374977100
—
FL
01
—
ME54748
MEDICAL LICENSE
FL
Enumeration date
06/08/2005
Last updated
11/28/2023
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