Provider Demographics
NPI:1063448074
Name:MANTINI REINOSO, DANIELLE Y (PA-C)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:Y
Last Name:MANTINI REINOSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:626-795-8051
Mailing Address - Fax:626-795-0356
Practice Address - Street 1:289 W HUNTINGTON DR STE 103
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3492
Practice Address - Country:US
Practice Address - Phone:626-821-0707
Practice Address - Fax:626-821-0239
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17136363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ03225Medicare UPIN
CAPA17136Medicare Oscar/Certification