Individual
AMANDA MANCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20325 N 51ST AVE STE 116, GLENDALE, AZ 85308-5665
(602) 933-1010
(602) 933-5395
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-3124
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
70186
AZ
208000000X
Pediatrics Physician
D94210
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187918
—
AZ
Enumeration date
03/28/2018
Last updated
01/16/2024
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