Provider Demographics
NPI:1861687410
Name:MARIA SONIA MANCILLA
Entity Type:Organization
Organization Name:MARIA SONIA MANCILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:SONIA
Authorized Official - Last Name:MANCILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-590-5337
Mailing Address - Street 1:10600 QUEZADA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10600 QUEZADA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3405
Practice Address - Country:US
Practice Address - Phone:915-590-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120565311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home