Provider Demographics
NPI:1821090473
Name:MANTHEI, DARLINA KESEG (DO)
Entity Type:Individual
Prefix:
First Name:DARLINA
Middle Name:KESEG
Last Name:MANTHEI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DARLINA
Other - Middle Name:
Other - Last Name:KESEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1801 W OLYMPIC BLVD # 2265
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:874 AMERICAN PACIFIC DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8800
Practice Address - Country:US
Practice Address - Phone:702-777-4809
Practice Address - Fax:702-777-4822
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV506207Q00000X, 207NS0135X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506105Medicaid
NVV105427Medicare PIN
F10586Medicare UPIN