MEDICARE: PSYCHIATRY BY MANTILLA-RIVAS

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598622656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRY BY MANTILLA-RIVAS

Provider Business Mailing Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:
Fax Number	:	757-432-3134

Provider Business Practice Location Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-201-9110
Fax Number	:	757-432-3134

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE OSCAR MANTILLA-RIVAS
Credential	:	MD
Telephone Number	:	904-201-9110

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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