| Doctor Name: | ROBERT J MANCINO |
| NPI Number: | 1124110762 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | RHT19556 |
| Business Practice Address: | 14810 Cresta Ave Clearlake, CA - 954228188 |
| Business Phone Number: | 7079944965 |
| Business Fax Number: | 7079944965 |
| Mailing Address: | Po Box 236, CLEARLAKE |
| State: | CA |
| Postal Code: | 954220236 |
| Phone Number: | 7079944965 |
| Fax Number: | 7079944965 |
| NPI Enumeration Date: | 09/29/2006 |
| NPI Last Update Date: | 12/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | RHT19556 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |