Provider Demographics
NPI:1780557124
Name:MANCILLA, ROGELIO
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:MANCILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:MANCILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7707 S 45TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68157-3919
Mailing Address - Country:US
Mailing Address - Phone:402-980-3896
Mailing Address - Fax:
Practice Address - Street 1:7707 S 45TH AVENUE CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68157-3919
Practice Address - Country:US
Practice Address - Phone:402-980-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker