ROBERT J MANCINO (NPI# 1124110762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124110762 |
| Entity Type | Individual |
| Full Name | ROBERT J MANCINO |
| Practice Address |
14810 Cresta Ave Clearlake CA 95422-8188 |
| Mailing Address |
Po Box 236 Clearlake CA 95422-0236 |
| Practice Telephone | 7079944965 |
| Practice Fax Number | 7079944965 |
| Mailing Telephone | 7079944965 |
| Mailing Fax Number | 7079944965 |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-12-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2471C3402X |
Radiologic Technologist Specialization: Radiography |
RHT19556 | CA | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDI-CAL | XR000131F | 01 |
| Street Address |
14810 CRESTA AVE |
| City | CLEARLAKE |
| State | CA |
| Zip Code | 95422-8188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
| 1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
| 1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
| 1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
| 1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
| 1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
| 1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
| 1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
| 1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
| 1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
| Find all providers in zip 95422 | ||||
| Taxonomy Code | 2471C3402X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Radiography |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1831657402 | Excel Imaging | Radiologic Technologist | 18158 Us Highway 18, Apple Valley, CA 92307-2202 | 2019-03-03 |
| 1568968899 | Conrado Olalia Quemuel | Radiologic Technologist | 242 Preble Dr, Tustin, CA 92780-3720 | 2018-04-04 |
| 1073036315 | United Mobile Rad LLC | Radiologic Technologist | 1720 E Cartagena St, Long Beach, CA 90807 | 2017-07-19 |
| 1134582083 | Bertha Patricia Orna | Radiologic Technologist | 1206 E 17th St Ste 205, Santa Ana, CA 92701-2641 | 2016-03-29 |
| 1467825703 | Jack Pavich | Radiologic Technologist | 9411 Sunnyside Ave, Ben Lomond, CA 95005-9345 | 2015-11-09 |
| 1306234703 | Socal Surgical Imaging | Radiologic Technologist | 10755 Scripps Poway Pkwy # 709, San Diego, CA 92131-3924 | 2015-01-07 |
| 1013320605 | Hera Nal | Radiologic Technologist | 406 E. Poppy St., Long Beach, CA 90805 | 2014-06-11 |
| 1245643279 | Coastal Diagnostic Services Inc | Radiologic Technologist | 1010 W La Veta Ave Ste 615, Orange, CA 92868-4310 | 2014-06-06 |
| 1003237439 | Amir Nahavandi | Radiologic Technologist | 6206 1/2 Nita Ave, Woodland Hills, CA 91367-7652 | 2014-01-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.