Amanda Michelle Mancilla

Primary specialty

OptometristTaxonomy code 152W00000X

License

34761 Issued in CA

Practice address

15330 Amar Rd
La Puente, CA 91744-2001

Phone

(626) 961-0432

NPI assigned

Jan 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: amanda.mancilla.p1@direct.fhccgla.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edward P. & Diane M. Hernandez

  • Optometrist
  • La Puente, CA
  • NPI 1568671774
  Medicare reassignment NPD
• Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • El Monte, CA
  • NPI 1225357114
  Medicare reassignment NPD
• DRS. Edward P. and Diane M. Hernandez, O.D.

  • Optometrist
  • Duarte, CA
  • NPI 1619186848
  NPD
• Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • Van Nuys, CA
  • NPI 1255729661
  NPD
• Southern California Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
  • NPI 1447865415
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1619567948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14220 BECKNER ST",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917462604",
            "telephone_number": "626-483-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15330 AMAR RD",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917442001",
            "telephone_number": "626-961-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLA",
        "first_name": "AMANDA",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan M Magno, MSW
• Viola B Mahrous
• Gil Magtibay Malaluan, D.M.D.
• Margarita Maldonado-Barragan, MPH, MCHES
• Dalia Ayad Malik, RPH
• Jorge Adrian Mancilla
• Carla Manjarrez, MA
• Julian E Mares
• Andrea Garcia Marino, PPS
• Alex Martel, D.M.D.

• Optometrist in La Puente, CA
• Providers in La Puente, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.