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General NPI Number Information
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NPI Number | 1386570091
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Entity Type | Individual
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Provider Name | MARIEL COLLEEN MANTIA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2026
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Last Update Date | 06/20/2026
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Provider Practice Location Address
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Address Line | 525 12TH ST
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City | OAKLAND
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State | CA
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Zip | 94607-4927
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Country | US
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Telephone | 800-607-6377
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Fax |
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Provider Business Mailing Address
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Address Line | 3775 FULMAR TER
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City | FREMONT
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State | CA
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Zip | 94555-1546
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Country | US
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Telephone | 408-420-6820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 95224817
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License Number State | CA
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