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General NPI Number Information
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NPI Number | 1215577689
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Entity Type | Individual
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Provider Name | JOCELYNE ELISA MANSILLA PA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 06/19/2021
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Provider Practice Location Address
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Address Line | 400 W 30TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90007-3320
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Country | US
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Telephone | 284-320-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 FOOTHILL BLVD STE E243
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City | LA CANADA
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State | CA
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Zip | 91011-1456
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Country | US
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Telephone | 818-419-4278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58341
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License Number State | CA
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