CARLOS A MANCILLA (Credential# 1424926) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
CARLOS A MANCILLA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0065484. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 679 Delaware Ave, Delmar, NY 12054-2417. The current status is active.
| Licensee Name | CARLOS A MANCILLA |
| Credential ID | 1424926 |
| Credential Number | CSP.0065484 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
679 Delaware Ave Delmar NY 12054-2417 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2017-05-23 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-02-26 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1488657 | 1.058052-RES | Resident Physician | 2017-07-01 | 2017-07-01 - 2020-06-30 | ACTIVE |
| Street Address | 679 DELAWARE AVE |
| City | DELMAR |
| State | NY |
| Zip Code | 12054-2417 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Diane Elizabeth Quinn | 7 Capital Avenue, Delmar, NY 12054 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Angeline Miles | 520 Kenwood Ave, Delmar, NY 12054 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Sebghatullah Abdullah | 42 Mansion Blvd, Delmar, NY 12054 | Professional Engineer | ~ |
| Myles K Hyman | 13 Windsor Court, Delmar, NY 12054 | Architect | 2019-08-01 ~ 2020-07-31 |
| David Bonney · Clearview Window & Siding | 13 Elm Ave, Delmar, NY 12054 | Home Improvement Salesperson | 1998-01-02 ~ 1998-11-30 |
| Timothy J Guernsey | 563 Kenwood Avenue, Delmar, NY 12054 | Registered Nurse | 2017-03-01 ~ 2018-02-28 |
| John C Braaten Md | 164 Jordan Blvd, Delmar, NY 12054 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Emma Walsh | 351 Wellington Road, Delmar, NY 12054 | Registered Nurse | 2016-01-01 ~ 2016-12-31 |
| Andrew H Toms | 20 Groesbeck Pl, Delmar, NY 12054 | Professional Engineer | 1995-01-18 ~ 1996-01-31 |
| Francis E Ferro · New York State Health Dept | 34 Carolanne Dr, Delmar, NY 12054 | Professional Engineer | 1989-02-21 ~ 1990-01-31 |
| Find all Licenses in zip 12054 | |||
| City | DELMAR |
| Zip Code | 12054 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + DELMAR |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carlos Holden | 64 Robbins St, Waterbury, CT 06708-2613 | Controlled Substance Registration for Practitioner | 2020-06-10 ~ 2021-02-28 |
| Carlos R Beltran Md | 300 George St Ste 901, New Haven, CT 06511-6662 | Controlled Substance Registration for Practitioner | 2009-05-06 ~ 2011-02-28 |
| Carlos A Henriquez | 188 Park St Fl 1, Hartford, CT 06106-2525 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Carlos W Vildozola Md | 62 Buckland St, Manchester, CT 06040 | Controlled Substance Registration for Practitioner | 2004-02-29 ~ 2005-02-28 |
| Carlos M. Cruz Chu | 52 Hawley Ave Apt 7, Milford, CT 06460-8100 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Carlos A Cardoso Md | 23 Hemlock Dr., Killingworth, CT 06419 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Carlos Rivera | 24 Hospital Ave, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2009-09-02 ~ 2011-02-28 |
| Carlos Morales | 24 Hospital Ave, Danbury, CT 06810-6077 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Carlos S. Degollado | 20 Hillside Ave, Unionville, CT 06085-1052 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Carlos A Gonzalez Md | 317 N. Main St, Manchester, CT 06042 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on CARLOS A MANCILLA.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).