MEDICARE: ANA MIRIAM MANTILLA ND

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	175F00000X	Naturopath	2006305-062-121	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669195954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA MIRIAM MANTILLA ND

Provider Business Mailing Address
First Line	:	1275 MORNING SUN WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2003
Country	:	US
Telephone Number	:	702-643-7336
Fax Number	:

Provider Business Practice Location Address
First Line	:	2851 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0435
Country	:	US
Telephone Number	:	702-658-0204
Fax Number	:	702-658-7177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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Directions to “ ANA MIRIAM MANTILLA ND” Practice Location

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