Mancilla, Amanda
Mancilla, Amanda is an individual health care provider with primary practice located at 20325 N 51St Ave Ste 116 , Glendale AZ 85308-5665. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Mancilla, Amanda can be contacted via phone (602) 933-1010.Contact Information
Primary practice address
20325 N 51St Ave Ste 116
Glendale AZ 85308-5665
Phone: (602) 933-1010
Fax: (602) 933-5395
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | D94210 | Maryland |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 70186 | Arizona |
Profile Details
| NPI number | 1417452632 |
|---|---|
| LBN Legal business name | Mancilla, Amanda |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 28th, 2018 |
| Last updated | Jan 16th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417452632 | NPPES |
| Arizona | MEDICAID | 187918 |
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