Provider Demographics
NPI:1659873040
Name:MANCIA, ERICK ARNOLD (IDC)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:ARNOLD
Last Name:MANCIA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33835 CHANNEL ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5618
Mailing Address - Country:US
Mailing Address - Phone:619-399-6609
Mailing Address - Fax:
Practice Address - Street 1:UNIT 100225 BOX 1
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96671-2500
Practice Address - Country:US
Practice Address - Phone:619-399-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman