Provider Demographics
NPI:1447759758
Name:PEDRE MANTILLA, DIONE
Entity Type:Individual
Prefix:
First Name:DIONE
Middle Name:
Last Name:PEDRE MANTILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 EL CEBRA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6623
Mailing Address - Country:US
Mailing Address - Phone:702-690-8251
Mailing Address - Fax:
Practice Address - Street 1:4306 EL CEBRA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6623
Practice Address - Country:US
Practice Address - Phone:702-690-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant