DR. GONZALO MANTILLA (NPI# 1629076799) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629076799 |
| Entity Type | Individual |
| Full Name | DR. GONZALO MANTILLA |
| Credential | M.D. |
| Practice Address |
12901 Bruce B Downs Blvd Mdc 15 Tampa FL 33612-4742 |
| Mailing Address |
P O Box 917770 Orlando FL 32891-7770 |
| Practice Telephone | 8132590840 |
| Mailing Telephone | 8132590840 |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2007-11-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
ME 22858 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD | 10926 | 01 |
| Street Address |
12901 BRUCE B DOWNS BLVD MDC 15 |
| City | TAMPA |
| State | FL |
| Zip Code | 33612-4742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538796784 | Samia Valeria Ozorio Dutra | Registered Nurse | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2020-03-26 |
| 1255966289 | Jessica Huang | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2020-03-10 |
| 1487218764 | Chelsea Gebs Black | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612-4742 | 2019-04-23 |
| 1609430925 | Kathryn Elizabeth Rudibaugh | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-23 |
| 1467015883 | Thomas Cole | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2019-04-22 |
| 1417510751 | Kelly Powell | Physician Assistant | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-22 |
| 1700347283 | Kristopher Johnson | Nurse Practitioner | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4799 | 2019-03-27 |
| 1366909129 | Derrik Jose Diaz Navarro | Specialist/Technologist | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2019-02-27 |
| 1346717717 | Kyle William Woodward | Specialist/Technologist | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4799 | 2018-10-24 |
| 1982193363 | Nicholas Angelo Mastromarino | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc 30, Tampa, FL 33612-4749 | 2018-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689286767 | Daniel Jimenez | Physical Therapist | 13000 Bruce B Downs Blvd, Tampa, Fl, Tampa, FL 33612 | 2020-08-19 |
| 1700426830 | Taz Stacy | Behavior Technician | 2701 University Square Drive, Tampa, FL 33612 | 2020-01-07 |
| 1841853215 | Eric Austen Keeler | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-20 |
| 1346700242 | Caitlyn Victoria Cartwright | Student in an Organized Health Care Education/Training Program | 12901 Bruce B. Downs Blvd., Mdc5, Tampa, FL 33612 | 2019-03-25 |
| 1720552953 | Marijo Bilitski | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd # Blvd5, Tampa, FL 33612 | 2019-01-22 |
| 1790259190 | Belkis Aleman | Nurse Practitioner | 205 E Busch Blvd, Tampa, FL 33612 | 2019-01-18 |
| 1811469133 | Stephanie Stegner | Physician Assistant | 12901 Bruce B Downs Blvd Mdc 5, Tampa, FL 33612 | 2018-12-27 |
| 1053889857 | Alysia Heather Siegel | Psychologist | 1300 Bruce B. Downs Boulevard, 116b, Tampa, FL 33612 | 2018-11-09 |
| 1295202489 | Daisy Baby Pulinilkumkalayil | Nurse Practitioner | 1426 W. Bush Blvd. Suite #105, Suite #105, Tampa, FL 33612 | 2018-10-26 |
| 1649745258 | Rachel Rene Shelton | Specialist/Technologist | Orthopedics and Sports Medicine, 13330 Usf Laurel Drive, Tampa, FL 33612 | 2018-10-10 |
| Find all providers in zip 33612 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710299581 | Whitney Blake Eldridge | Pediatrics | 4321 N Macdill Ave Ste 304, Tampa, FL 33607-6390 | 2010-07-09 |
| 1578590832 | Alfonso Vargas IIi | Pediatrics | 3030 W Martin Luther King Jr Blvd, Tampa, FL 33607 | 2006-06-26 |
| 1164477980 | Julie Carvajal Mendoza | Pediatrics | 3030 W. Dr. Mlk Jr. Blvd, Tampa, FL 33607-6308 | 2006-05-23 |
| 1669435335 | Kenneth J Solomon | Pediatrics | 3030 W Dr Martin Luther King Jr Blvd, Tampa, FL 33607-6308 | 2006-04-11 |
| 1306264361 | Kejal Karishma Patel Desai | Pediatrics | 17 Davis Blvd, Suite 308, Tampa, FL 33606-3475 | 2014-04-06 |
| 1770834772 | Keyur Thakarshibhai Donda | Pediatrics | 2 Tampa General Cir, Tampa, FL 33606-3603 | 2012-10-01 |
| 1821317215 | Jaime A Flores-torres | Pediatrics | 2 Tampa General Cir, J402, Tampa, FL 33606-3603 | 2010-05-25 |
| 1386846533 | Eric Thompson Rabenstein | Pediatrics | 4321 N Macdill Ave, Suite 304, Tampa, FL 33607-6388 | 2007-06-01 |
| 1730235672 | Thao B Ho | Pediatrics | 2 Tampa General Cir, Stc 5th Floor, Tampa, FL 33606-3603 | 2007-01-25 |
| 1922156561 | Maya Balakrishnan | Pediatrics | 2 Tampa General Cir, Tampa, FL 33606-3603 | 2007-01-08 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.