Provider Demographics
NPI:1063739340
Name:MICHAEL S MANCINA MD AND ASSSOCIATES OF CALIFORNIA
Entity type:Organization
Organization Name:MICHAEL S MANCINA MD AND ASSSOCIATES OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-888-8866
Mailing Address - Street 1:901 W 43RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3133
Mailing Address - Country:US
Mailing Address - Phone:913-888-8866
Mailing Address - Fax:
Practice Address - Street 1:22101 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-7107
Practice Address - Country:US
Practice Address - Phone:816-888-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1G55174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty