Individual
ROBERT J MANCINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14810 CRESTA AVE, CLEARLAKE, CA 95422-8188
(707) 994-4965
(707) 994-4965
Mailing address
PO BOX 236, CLEARLAKE, CA 95422-0236
(707) 994-4965
(707) 994-4965
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
RHT19556
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XR000131F
MEDI-CAL
CA
Enumeration date
09/29/2006
Last updated
12/13/2007
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