Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA08534100 | NJ |
N | 208000000X | Pediatrician | MD049248L | PA |
N | 2080P0205X | Pediatric Endocrinologist | 25MA08534100 | NJ |
Y | 2080P0205X | Pediatric Endocrinologist | MD049248L | PA |
NPI | 1427284314 |
---|---|
Provider Name | Edna Mancilla |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 15/04/2013 |