Penelope Mantilla, SA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

10500 NW 74TH St Apt 2-102
Medley, FL 33178-2400

Phone

(312) 672-2209

NPI assigned

Jan 14, 2021

Last updated

Jan 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1215526165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10500 NW 74TH ST APT 2-102",
            "city": "MEDLEY",
            "state": "FL",
            "postal_code": "331782400",
            "telephone_number": "312-672-2209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10500 NW 74TH ST APT 2-102",
            "city": "MEDLEY",
            "state": "FL",
            "postal_code": "331782400",
            "telephone_number": "312-672-2209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTILLA",
        "first_name": "PENELOPE",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-14",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Link, PHYSICAL THERAPIST
• Alfredo Llop
• Keyling Lopez, PHARM D
• Dalia Lorenzo, MD
• Brian Mangan, PSY.D., ABPP
• Leroy Anselm Marklund, ARNP
• Roxana Martinez Abreu
• Manuel Martinez, PHARM. D.
• Veronica McCloskey, MD
• Medcore Labs Inc

• Surgical Physician Assistant in Medley, FL
• Providers in Medley, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.