Healthcare Provider Details

I. General information

NPI: 1790690550
Provider Name (Legal Business Name): CECILIA ARZATE MANCINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

916 E DEODAR ST APT G
ONTARIO CA
91764-1375
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-1233
  • Fax: 909-621-5999
Mailing address:
  • Phone: 909-624-1233
  • Fax: 909-621-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: