Individual
MRS. DIANE MANTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, CCM
Contact information
Practice address
12150 MONUMENT DR, FAIRFAX, VA 22033-4051
(757) 270-2452
(770) 723-8586
Mailing address
1391 NW 136TH AVE, SUNRISE, FL 33323-2800
(757) 270-2452
(770) 723-8586
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
0001105385
VA
Other
Enumeration date
12/16/2021
Last updated
12/16/2021
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