Provider Demographics
NPI:1386881779
Name:MANCILLA, ALEJANDRO (DPT)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:MANCILLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:MANCILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2400 S FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2629
Mailing Address - Country:US
Mailing Address - Phone:213-742-1450
Mailing Address - Fax:213-742-1453
Practice Address - Street 1:2400 S FLOWER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2629
Practice Address - Country:US
Practice Address - Phone:213-742-1450
Practice Address - Fax:213-742-1453
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist