Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1619170370 |
---|---|
Provider Name | Virginia Mancillas |
First Address | Corpus Christi, TX 78463-1580 |
Second Address | Mcallen, TX 78501-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 08/07/2007 |