Individual
IMELDA D. MANTILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
777 BLOOMFIELD AVE, CLIFTON, NJ 07012-1242
(973) 594-0125
(973) 594-0536
Mailing address
777 BLOOMFIELD AVE, CLIFTON, NJ 07012-1242
(973) 594-0125
(973) 594-0536
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
NJ
Other
Enumeration date
10/10/2017
Last updated
10/10/2017
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