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NPI Code Detail

MEDICARE: DIANA MANTILLA DO

MEDICARE: DIANA MANTILLA DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMO

General Provider Information

NPI Number : 1558205278
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA MANTILLA DO
Provider Business Mailing Address
First Line : 7325 QUIVIRA RD APT 1252
Second Line :
City : SHAWNEE
State : KS
Zip : 66216-3622
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-3220
Country : US
Telephone Number : 816-932-6009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “ DIANA MANTILLA DO” Practice Location

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