Provider Demographics
NPI:1558894204
Name:MANCILLA, CARLOS ARTURO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ARTURO
Last Name:MANCILLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4172
Mailing Address - Country:US
Mailing Address - Phone:623-683-4462
Mailing Address - Fax:623-683-4963
Practice Address - Street 1:34975 N NORTH VALLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4029
Practice Address - Country:US
Practice Address - Phone:623-295-4820
Practice Address - Fax:623-295-4830
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66877207P00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program