JORGE MANTILLA (NPI# 1962065516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962065516 |
| Entity Type | Individual |
| Full Name | JORGE MANTILLA |
| Credential | SA-C |
| Practice Address |
5540 N Kimball Ave Apt 3e Chicago IL 60625-4674 |
| Practice Telephone | 3129830540 |
| Mailing Telephone | 3129830540 |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-02-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
238.000655 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 246ZC0007X |
Specialist/Technologist, Other Specialization: Surgical Assistant |
19-180 | TX | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
5540 N KIMBALL AVE APT 3E |
| City | CHICAGO |
| State | IL |
| Zip Code | 60625-4674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726615 | B Wise Rehabilitation Pllc | Physical Therapist | 4754 N Lincoln Ave, Fl 1, Chicago, IL 60625 | 2020-10-07 |
| 1700490448 | Anita Saini | Pharmacist | 5140 N California Ave, Chicago, Il 60625, Chicago, IL 60625 | 2020-09-01 |
| 1699303164 | Marina Karamanis | Student in an Organized Health Care Education/Training Program | Swedish Hospital, 5140 N. California Ave, Chicago, IL 60625 | 2020-03-31 |
| 1063050227 | Jacqueline Guadalupe Saldana | Behavioral Analyst | 8616 W Catalpa Ave, Suite 1106, Chicago, IL 60625 | 2019-12-18 |
| 1912557802 | Six Senses Therapy LLC | Social Worker | 2334 W. Lawrence Avenue, Suite 204c, Chicago, IL 60625 | 2019-09-13 |
| 1982266110 | Noreen Randhawa | Family Medicine | Swedish Hospital Part of North Shore, 5145 N. California Ave., Chicago, IL 60625 | 2019-07-09 |
| 1376102202 | Nita Gupta | Student in an Organized Health Care Education/Training Program | Graduate Medical Education Department, 5145 N. California Ave, Chicago, IL 60625 | 2019-06-13 |
| 1841763471 | Alexandra Taskier | Counselor | 5359 N Bowmanville Ave., Chicago, IL 60625 | 2019-01-07 |
| 1013490143 | Paula Bielnicka | Pharmacist | Swedish Covenant Hospital - Pharmacy, 5140 N California Ave, Chicago, IL 60625 | 2018-09-14 |
| 1902397078 | Rebecca Abraham | Hospitalist | 5145 N California Ave Ofc M331, Chicago, IL 60625 | 2018-05-24 |
| Find all providers in zip 60625 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1407331184 | David Reyes | Physician Assistant | 2800 N Sheridan Rd Ste 209, Chicago, IL 60657-6157 | 2018-09-28 |
| 1053899138 | Won Hee Oh | Physician Assistant | 5841 S. Maryland Ave., Mc5040, Chicago, IL 60637 | 2018-08-01 |
| 1811494917 | Nicole Fisch | Physician Assistant | 7447 W Talcott Ave Ste 512, Chicago, IL 60631-3716 | 2018-04-06 |
| 1477909448 | Temidayo Olugbenga Odugbesan | Physician Assistant | 7016 S Sangamon St, Apt 3s, Chicago, IL 60621-1759 | 2016-05-10 |
| 1689096257 | Natalie Elizabeth Warmuth | Physician Assistant | 830 West Diversey Pkwy., Suite 300, Chicago, IL 60614-8711 | 2014-01-15 |
| 1184062754 | Lindsay Christine Jones | Physician Assistant | 205 East Huron, Northwestern Memorial Hospital Galter 11-140, Chicago, IL 60611 | 2013-06-05 |
| 1366741449 | Monica L Fiehler | Physician Assistant | 3537 Paysphere Cir, Chicago, IL 60674-0001 | 2011-03-15 |
| 1700187861 | Megan Anne Ferraro | Physician Assistant | 675 N Saint Clair St Ste 11-140, Chicago, IL 60611-5975 | 2010-11-05 |
| Find all providers in CHICAGO | ||||
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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.