MEDICARE: DR. CARLOS ARTURO MANCILLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	66877	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	66877	AZ

General Provider Information

NPI Number	:	1558894204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ARTURO MANCILLA M.D.

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4172
Country	:	US
Telephone Number	:	623-683-4462
Fax Number	:	623-683-4963

Provider Business Practice Location Address
First Line	:	34975 N NORTH VALLEY PKWY STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-4029
Country	:	US
Telephone Number	:	623-295-4820
Fax Number	:	623-295-4830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	03/19/2025

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