Individual
DR. FANNY MANTILLA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
4422 3RD AVE, CARE OF ER DEPARTMENT, BRONX, NY 10457-2545
(718) 960-6103
Mailing address
4422 3RD AVE, CARE OF ER DEPARTMENT, BRONX, NY 10457-2545
(718) 960-6103
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
212807
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02321259
—
NY
Enumeration date
05/20/2006
Last updated
07/08/2007
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