Individual
GUILLERMO ALBERTO MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6555 COYLE AVE STE 280, CARMICHAEL, CA 95608-0302
(916) 536-3540
(916) 536-3541
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
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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