Individual
LEON SAMUEL MANCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5555 RESERVOIR DR, SAN DIEGO, CA 92120-5134
(619) 822-1800
Mailing address
5555 RESERVOIR DR, SAN DIEGO, CA 92120-5134
(619) 822-1800
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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