Provider Demographics
NPI:1669032637
Name:MANTILLA, OSCAR JR
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:MANTILLA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 SCHOLTZ CT APT 4
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4468
Mailing Address - Country:US
Mailing Address - Phone:305-393-3080
Mailing Address - Fax:
Practice Address - Street 1:1634 SCHOLTZ CT APT 4
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4468
Practice Address - Country:US
Practice Address - Phone:305-393-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)