Jose Luis Mancilla Jr.

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

7903 Issued in CA

Practice address

30250 Rancho Viejo Rd Ste a
San Juan Capistrano, CA 92675-1555

Phone

(949) 489-0668

Fax

(949) 489-1475

NPI assigned

Mar 17, 2021

Last updated

May 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Connect Hearing Inc

  • Hearing Aid Equipment
  • Aurora, IL
  • NPI 1265700942

  Hearing Instrument Specialist

  NPD

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1912582289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N COMMONS DR STE 200",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047940",
            "telephone_number": "630-303-5380",
            "fax_number": "630-303-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30250 RANCHO VIEJO RD STE A",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751555",
            "telephone_number": "949-489-0668",
            "fax_number": "949-489-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLA",
        "first_name": "JOSE",
        "middle_name": "LUIS",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "CA",
            "license": "7903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEARING INSTRUMENT SPECIALIST",
            "identifier": "7903",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerry Luong
• Kathleen Ann Lynch, M.D.
• Dania Magill, B.S.
• Mallery Dental Corporation (Capistrano Dental Group)
• Mary Claire Malooly, PT, DPT, ATC
• Pat Anne Mann, M.A.
• Jennifer Rebecca Mansoor
• Derek Mantey, MS, ATC, PTA
• Marcum Psychological Services Corp
• Maria Theresa Baylon-D'Souza (Flex Physical Therapy)

• Hearing Instrument Specialist in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Hearing Instrument Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.