Individual provider · Type 1 NPI

Jorge Mantilla, SA-C

Surgical Physician Assistant · Chicago, IL

NPI number 1962065516 Active

Practice location

5540 N Kimball Ave Apt 3E
Chicago, IL 60625-4674

Call (312) 983-0540 Map

Specialties and licenses

TaxonomyCodeLicense
Surgical Assistant 246ZC0007X19-180 (TX)
Surgical Physician Assistant Primary 363AS0400X238.000655 (IL)

Surgical Physician Assistant: Definition to come...

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About NPI 1962065516

Jorge Mantilla, SA-C's National Provider Identifier is 1962065516, issued on Apr 18, 2019. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Chicago, IL. The record was last updated on Feb 11, 2020.