Provider Demographics
NPI:1255343901
Name:CADENA, GUILLERMO MANTILLA (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:MANTILLA
Last Name:CADENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 HEARTH RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-3714
Mailing Address - Country:US
Mailing Address - Phone:813-997-3802
Mailing Address - Fax:
Practice Address - Street 1:22770 SKYVIEW CIR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-3106
Practice Address - Country:US
Practice Address - Phone:813-997-3802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00193462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05067111000Medicaid
FL29705Medicare ID - Type Unspecified
FL05067111000Medicaid