Healthcare Provider Details

I. General information

NPI: 1093652588
Provider Name (Legal Business Name): EASTLAND NEUROPSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TERRADO PLZ STE 104
COVINA CA
91723-3411
US

IV. Provider business mailing address

750 TERRADO PLZ STE 104
COVINA CA
91723-3411
US

V. Phone/Fax

Practice location:
  • Phone: 626-859-0500
  • Fax: 626-859-0400
Mailing address:
  • Phone: 626-859-0500
  • Fax: 626-859-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL MANCILLAS PHD
Title or Position: OWNER/DIRECTOR
Credential: PHD
Phone: 626-859-0500