Provider Demographics
NPI:1265837546
Name:EVELIA MANCERA
Entity Type:Organization
Organization Name:EVELIA MANCERA
Other - Org Name:SANTA FE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-240-4174
Mailing Address - Street 1:HERMANOS ESCOBAR
Mailing Address - Street 2:2456
Mailing Address - City:CD. JUAREZ
Mailing Address - State:CHIHUAHUA
Mailing Address - Zip Code:32300
Mailing Address - Country:MX
Mailing Address - Phone:915-613-4145
Mailing Address - Fax:
Practice Address - Street 1:4517 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-1210
Practice Address - Country:US
Practice Address - Phone:915-240-4174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2643666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty