Provider Demographics
NPI:1588687925
Name:MANSILLA, DISBEL REBECA (DDS)
Entity type:Individual
Prefix:DR
First Name:DISBEL
Middle Name:REBECA
Last Name:MANSILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BISHOP ST BLDG D
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4635
Mailing Address - Country:US
Mailing Address - Phone:805-547-7013
Mailing Address - Fax:805-547-7014
Practice Address - Street 1:1551 BISHOP ST BLDG D
Practice Address - Street 2:SUITE 420
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-547-7013
Practice Address - Fax:805-547-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist