Individual
PAUL JOSEPH MANCILLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
100 S. CITRUS AVE, STE 206, COVINA, CA 91723
(626) 331-6999
(626) 331-8551
Mailing address
330 S. LA SERENA DR., WEST COVINA, CA 91791
(626) 339-1158
(626) 331-8551
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY10364
CA
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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