MR. JESUS MANCILLA SR. (NPI# 1205965050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205965050 |
| Entity Type | Individual |
| Full Name | MR. JESUS MANCILLA SR. |
| Credential | RSA |
| Practice Address |
3538 W Fullerton Ave Chicago IL 60647-2443 |
| Mailing Address |
8021 42nd Ct Lyons IL 60534-1165 |
| Practice Telephone | 7737721212 |
| Mailing Telephone | 7084421172 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | IL | Other Service Providers |
| Street Address |
3538 W FULLERTON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60647-2443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730100173 | Andrew Gorchynsky | Surgery | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2006-07-21 |
| 1457532822 | Solaris Diagnostics PC | Pathology | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2007-11-14 |
| 1639295108 | Garcia Radiology PC | Radiology | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2007-03-22 |
| 1043336530 | Cardinal Surgery Systems PC | Internal Medicine | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2007-03-22 |
| 1629194113 | Logan Square Anesthesia PC | Anesthesiology | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2007-03-22 |
| 1124178330 | Ramon A Garcia Md PC | Internal Medicine | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2007-01-11 |
| 1235295999 | Ramon Andres Garcia Jr. | Internal Medicine | 3538 W Fullerton Ave, Chicago, IL 60647-2443 | 2006-12-28 |
| 1063518488 | Yolanda Lalyre-rodriguez | Internal Medicine | 3538 W Fullerton Ave, Mc 716, Chicago, IL 60647-2443 | 2006-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164035879 | Scott Spine and Health LLC | Chiropractor | 2560 W. Armitage Ave, Unit C2, Chicago, IL 60647 | 2020-08-24 |
| 1003424458 | Emily Gleesing | Physical Therapist | 1923 N Western Ave, Chicago, IL 60647 | 2020-07-21 |
| 1699301358 | Marcella Guzman P.C. | Dentist | 3236 W. Fullerton Ave., Chicago, IL 60647 | 2020-03-13 |
| 1740772342 | Envision Unlimited | Case Management | 2646 N Washtenaw Ave # 3n, Chicago, IL 60647 | 2018-05-31 |
| 1992297535 | Envision Unlimited | Case Management | 2646 N Washtenaw Ave # 2n, Chicago, IL 60647 | 2018-05-30 |
| 1942704580 | Team Rehabilitation Il15, LLC | Physical Therapist | 1923 N Western Avenue, Chicago, IL 60647 | 2018-03-20 |
| 1023517331 | Chicago Medical Healthcare Group, S.c. | Family Medicine | 3648 W Armitage Avenue, Chicago, IL 60647 | 2018-02-02 |
| 1023537693 | Erin Frommeyer | Physician Assistant | 2228 W Dickens Avenue, Chicago, IL 60647 | 2017-09-15 |
| 1457872475 | Stefanie Paola Maurtua | Behavioral Analyst | 2448 West Bloomingdale Ave., Apt 2e, Chicago, IL 60647 | 2017-06-29 |
| 1700322922 | Lumen Optical Illinois 4, LLC | Optometrist | 2420 N Elston, Bucktown, IL 60647 | 2017-01-11 |
| Find all providers in zip 60647 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346899630 | Jeremy Gantz Morse | Specialist | 815 W Buena Ave, Chicago, IL 60613-1694 | 2019-09-09 |
| 1619539632 | Benjamin Mendoza | Specialist | 6303 W 63rd St Unit 3c, Chicago, IL 60638-7015 | 2019-06-29 |
| 1811471808 | Judith M Penn | Specialist | 8312 S Kedzie Ave, Chicago, IL 60652-3309 | 2018-09-17 |
| 1841774825 | Matthew E Huggins | Specialist | 4553 W 56th St Apt 204c, Chicago, IL 60629-5389 | 2018-09-17 |
| 1750860177 | Muhammad Asim Khan | Specialist | 60 E Delaware Pl, Chicago, Il 60611, 14th Floor Urology- Andrology Clinic, Chicago, IL 60611 | 2018-08-07 |
| 1922502657 | Shauntay Robertson | Specialist | 7342 S Richmond St, Chicago, IL 60629-3015 | 2018-03-19 |
| 1114448644 | Ageless Men's Health Holdings Inc | Specialist | 1729 N Clybourn Ave, Chicago, IL 60614-6503 | 2017-07-06 |
| 1447798871 | Andria Miller | Specialist | 840 N Western Ave, Chicago, IL 60622-4638 | 2017-02-06 |
| 1710425129 | Rtb Sc | Specialist | 5015 N. Paulina #225, Chicago, IL 60640 | 2017-02-06 |
| 1881137354 | Joy Deliverance Williamson | Specialist | 3863 W Flournoy St, Apt. 1w, Chicago, IL 60624-3617 | 2016-11-30 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.