Provider Demographics
NPI:1356125272
Name:MANCIO, LAURA PATRICIA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PATRICIA
Last Name:MANCIO
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 1:6711 ARLINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1966
Mailing Address - Country:US
Mailing Address - Phone:951-352-4964
Mailing Address - Fax:951-352-4965
Practice Address - Street 1:6711 ARLINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1966
Practice Address - Country:US
Practice Address - Phone:951-352-4964
Practice Address - Fax:951-352-4965
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker