Paul Joseph Mancillas, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY10364 Issued in CA

Practice address

100 S. Citrus Ave
Ste 206
Covina, CA 91723

Phone

(626) 331-6999

Fax

(626) 331-8551

NPI assigned

Oct 4, 2006

Sex

Male

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Eastland Neuropsychology Group

  • Clinical Neuropsychologist
  • Covina, CA
  • NPI 1093652588
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689769622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 S. LA SERENA DR.",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91791",
            "telephone_number": "626-339-1158",
            "fax_number": "626-331-8551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S. CITRUS AVE",
            "address_2": "STE 206",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "91723",
            "telephone_number": "626-331-6999",
            "fax_number": "626-331-8551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLAS",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY10364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Rose Navoa Mananzan
• Marcus Manapat
• Munchita Manaspienlert
• Jeffrey Lee Mancaruso
• Joshua Paul Manchester
• Amanda Marie Manes
• Mimi Mangune
• Kyndall M Mann
• Titus Manuele
• Chris Manus

• Clinical Neuropsychologist in Covina, CA
• Providers in Covina, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.