Doctor Name: | MS. ANA MARISELA MANCILLA |
NPI Number: | 1003065020 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 876 |
Business Practice Address: | 1530 S Olive St Los Angeles, CA - 900153023 |
Business Phone Number: | 2137461037 |
Business Fax Number: | |
Mailing Address: | 938 N Benton Way, LOS ANGELES |
State: | CA |
Postal Code: | 900263826 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/15/2008 |
NPI Last Update Date: | 09/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2355S0801X |
License Number: | 876 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Specialist/Technologist |
Taxonomy Specialization: | Speech-Language Assistant |
Taxonomy Definition: |