Mantilla, Gonzalo
Mantilla, Gonzalo is an individual health care provider with primary practice located at 777 Franklin Gtwy Se , Marietta GA 30067-7803. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, which is considered as his primary health care specialty. Mantilla, Gonzalo can be contacted via phone (770) 732-6007.Contact Information
Primary practice address
777 Franklin Gtwy Se
Marietta GA 30067-7803
Phone: (770) 732-6007
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine | 2080N0001X | ME 22858 | Florida |
Profile Details
| NPI number | 1629076799 |
|---|---|
| LBN Legal business name | Mantilla, Gonzalo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2005 |
| Last updated | May 18th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629076799 | NPPES |
| Florida | Other | 10926 | BLUE CROSS BLUE SHIELD |
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