Individual
ANNISSA MANCILLAS I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1912 E LAKE AVE, WATSONVILLE, CA 95076-2325
(831) 515-9194
Mailing address
1912 E LAKE AVE, WATSONVILLE, CA 95076-2325
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
CA
Other
Enumeration date
10/17/2025
Last updated
10/17/2025
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