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General NPI Number Information
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NPI Number | 1437646569
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Entity Type | Individual
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Provider Name | BRYANNA MANTILLA MD, PHD, MPH
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Gender | Female
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 9801 FRONTIER AVE SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-5200
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Country | US
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Telephone | 425-831-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 TRINITY ST STOP A
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City | AUSTIN
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State | TX
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Zip | 78712-1766
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Country | US
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Telephone |
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | U4260
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD61155824
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License Number State | WA
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