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General NPI Number Information
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NPI Number | 1558894204
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Entity Type | Individual
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Provider Name | CARLOS ARTURO MANCILLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 34975 N NORTH VALLEY PKWY STE 100
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City | PHOENIX
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State | AZ
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Zip | 85086-4029
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Country | US
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Telephone | 623-295-4820
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Fax | 623-295-4830
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Provider Business Mailing Address
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Address Line | 2500 W UTOPIA RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85027-4172
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Country | US
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Telephone | 623-683-4462
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Fax | 623-683-4963
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 66877
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License Number State | AZ
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Taxonomy #2
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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 #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66877
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License Number State | AZ
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