Healthcare Provider Details

I. General information

NPI: 1285577635
Provider Name (Legal Business Name): ADA MANCILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9382 BIGBY ST
DOWNEY CA
90241-2903
US

IV. Provider business mailing address

7403 SIDEVIEW DR
PICO RIVERA CA
90660-4245
US

V. Phone/Fax

Practice location:
  • Phone: 951-642-7630
  • Fax:
Mailing address:
  • Phone: 562-201-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: