Search › Illinois › 363AS0400X
Jorge Mantilla, SA-C
NPI 1962065516 · on the registry since 2019 · sole proprietor
Practice
- Address
- 5540 N Kimball Ave Apt 3e
Chicago, IL 60625 - Phone
- (312) 983-0540
Registry record
- Primary taxonomy
- 363AS0400X
363AS0400X
- Also registered as
- 246ZC0007X
- Licence states on file
- TX, IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2020-02-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois