Provider Demographics
NPI:1235453770
Name:MANCIAS, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MANCIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAUREL PL
Mailing Address - Street 2:APT. 2
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2052
Mailing Address - Country:US
Mailing Address - Phone:415-342-6409
Mailing Address - Fax:
Practice Address - Street 1:830 B ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3003
Practice Address - Country:US
Practice Address - Phone:415-459-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner