Healthcare Provider Details

I. General information

NPI: 1558019844
Provider Name (Legal Business Name): ANA CLAUDIA MANCILLA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 N GAREY AVE
POMONA CA
91767-2722
US

IV. Provider business mailing address

2008 N GAREY AVE
POMONA CA
91767-2722
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6131
  • Fax:
Mailing address:
  • Phone: 909-623-6131
  • Fax: 909-865-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC11617
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: