Individual provider Active NPI

Hafid Mantilla, MD

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1629370861
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C180533 Issued in CA
Practice address
10670 Wexford St
San Diego, CA 92131-3940
Phone
(858) 499-2600
NPI assigned
Nov 19, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C180533 CA Primary

Addresses

Primary practice location

10670 Wexford St
San Diego, CA 92131-3940

Mailing address

5651 Copley Dr Ste a
San Diego, CA 92111-7903
Phone (858) 262-6072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230829002397 CA Practitioner - Pediatric Medicine 3375816887 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C180533CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc Pediatrics CurrentSince Aug 7, 2023 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Aug 7, 2023 Accepting new patients
Rady Children'S Hospital San Diego Past Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients

Locations

10670 Wexford St
San Diego, CA 92131
Phone (858) 621-4010

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

5651 Copley Dr
Ste A
San Diego, CA 92111
Phone (858) 262-6109

5651 Copley Dr
San Diego, CA 92111
Phone (858) 262-6340

Interoperability endpoints

  • Direct secure messaging: hmantilla25006@sharphealthcare.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1629370861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5651 COPLEY DR STE A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117903",
            "telephone_number": "858-262-6072",
            "fax_number": "858-262-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10670 WEXFORD ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313940",
            "telephone_number": "858-499-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTILLA",
        "first_name": "HAFID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-19",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C180533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.