Provider Demographics
NPI:1922281831
Name:MANCEBO, CINDY K
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:K
Last Name:MANCEBO
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 1:21480 ROAD 16
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-9730
Mailing Address - Country:US
Mailing Address - Phone:559-908-8083
Mailing Address - Fax:
Practice Address - Street 1:500 N WESTBERRY BLVD
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-6005
Practice Address - Country:US
Practice Address - Phone:559-908-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist