Individual
JOSE LUIS MANCILLA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30250 RANCHO VIEJO RD STE A, SAN JUAN CAPISTRANO, CA 92675-1555
(949) 489-0668
(949) 489-1475
Mailing address
750 N COMMONS DR STE 200, AURORA, IL 60504-7940
(630) 303-5380
(630) 303-5385
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
7903
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7903
HEARING INSTRUMENT SPECIALIST
CA
Enumeration date
03/17/2021
Last updated
05/05/2021
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