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NPI Code Detail

MEDICARE: ANTHONY MANCUSO

MEDICARE: ANTHONY MANCUSO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1467314252
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY MANCUSO
Provider Business Mailing Address
First Line : 5554 RESEDA BLVD STE 203
Second Line :
City : TARZANA
State : CA
Zip : 91356-6212
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5554 RESEDA BLVD STE 203
Second Line :
City : TARZANA
State : CA
Zip : 91356-6212
Country : US
Telephone Number : 818-705-5522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ ANTHONY MANCUSO ” Practice Location

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