LEON SAMUEL MANCILLA (NPI# 1376140590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376140590 |
| Entity Type | Individual |
| Full Name | LEON SAMUEL MANCILLA |
| Other Name | LEON SAMUEL LOEB-MANCILLA |
| Practice Address |
5555 Reservoir Dr San Diego CA 92120-5134 |
| Practice Telephone | 6198221800 |
| Mailing Telephone | 6198221800 |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
5555 RESERVOIR DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92120-5134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225035496 | William Patrick Mann | Internal Medicine | 5555 Reservoir Dr, Ste 200, San Diego, CA 92120-5134 | 2005-07-04 |
| 1417345091 | Btla Vi | Internal Medicine | 5555 Reservoir Dr, Suite #209, San Diego, CA 92120-5134 | 2015-01-05 |
| 1295050102 | Ashley Winter | Urology | 5555 Reservoir Dr, Suite 300, San Diego, CA 92120-5134 | 2010-04-02 |
| 1215251822 | Farhad Farjoudi | Internal Medicine | 5555 Reservoir Dr, Ste 312, San Diego, CA 92120-5173 | 2010-03-25 |
| 1932438637 | Charles R. Kossman, M.d., Inc. | Internal Medicine | 5555 Reservoir Dr, #306, San Diego, CA 92120-5134 | 2009-12-09 |
| 1699906032 | Azam Shamani | Family Medicine | 5555 Reservoir Dr, Ste 312, San Diego, CA 92120-5134 | 2009-08-03 |
| 1841447950 | Brooke Laura Ballard | Orthopaedic Surgery | 5555 Reservoir Dr, Ste 104, San Diego, CA 92120-5134 | 2008-08-20 |
| 1679747448 | Brett A Gidney Md A Medical Corporation | Internal Medicine | 5555 Reservoir Dr, Suite 112, San Diego, CA 92120-5134 | 2008-04-14 |
| 1982886107 | Richard A Katz M D Inc | Internal Medicine | 5555 Reservoir Dr, Suite 112, San Diego, CA 92120-5195 | 2007-11-29 |
| 1952595316 | Ralph Erik Rynning | Orthopaedic Surgery | 5555 Reservoir Dr, Suite 104, San Diego, CA 92120-5134 | 2007-08-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316550510 | Jessica Elizabeth Knight | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Ct, 310, San Diego, CA 92120 | 2020-08-26 |
| 1770195091 | Julia Roccanova | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Court, Suite 310, San Diego, CA 92120 | 2020-08-18 |
| 1225593601 | Truself Training, Inc | Clinic/Center | 5125 Waring Road, San Diego, CA 92120 | 2019-02-09 |
| 1508381799 | Antin Sachs | In Home Supportive Care | 4420 Rainier Avenue, Suite 202, San Diego, CA 92120 | 2017-08-08 |
| 1588186415 | Matthew B Wilbat | Behavioral Analyst | 6851 Alvarado Rd., #17, San Diego, CA 92120 | 2017-07-12 |
| 1548782923 | Mori Khatibzadeh Dds Inc. | Clinic/Center | 6171 Mission Gorge Road, Suite #114, San Diego, CA 92120 | 2017-07-07 |
| 1306379359 | Ken Samith Oerding | Nurse Practitioner | 5422 Reservoir Drive, E7, San Diego Ca, CA 92120 | 2017-04-06 |
| 1396134409 | Debra Michele Stern-ellis | Social Worker | 4647 Zion Avenue Kaiser Permanente, 2nd Floor - Oncology, San Diego, CA 92120 | 2015-01-13 |
| 1821494717 | Shohreh Tourian | Dentist | 7451 Mission Gorge Road, San Diego, CA 92120 | 2014-11-05 |
| 1184049215 | Charles Yin | Counselor | 6153 Fairmount Ave Suite #260, San Diego, CA 92120 | 2014-02-26 |
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| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043826753 | Dayjahnay Shantay Davenport | Peer Specialist | 3347 Lincoln Ave, San Diego, CA 92104-2111 | 2020-09-17 |
| 1427683101 | Gerardo Castro | Peer Specialist | 5555 Reservoir Dr # 204-a, San Diego, CA 92120-5134 | 2020-03-03 |
| 1487298840 | Garrett Ives | Peer Specialist | 2909 Keats St Apt 7, San Diego, CA 92106-2345 | 2019-10-29 |
| 1144882622 | Melissa Ratsamy | Peer Specialist | 286 Euclid Ave Project Enable, #102, San Diego, CA 92114 | 2019-07-03 |
| 1699258459 | Talya Donahue | Peer Specialist | 1045 Ninth Ave, San Diego, CA 92101 | 2018-09-07 |
| 1811434467 | Deborah Sue Lynn | Peer Specialist | 140 W. Arbor Dr., Ucsd Gifford Outpatient Clinic, San Diego, CA 92103-2421 | 2017-01-20 |
| 1023463163 | Miguel Pablo Surposa | Peer Specialist | 5711 Bolivar St, San Diego, CA 92139-1617 | 2016-04-26 |
| 1982210092 | Nicole Lynn Iwan | Peer Specialist | 3491 Kurtz St Ste 150, San Diego, CA 92110-4430 | 2020-09-23 |
| 1962014001 | Paulina Alvarado | Peer Specialist | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-08-19 |
| 1194333773 | Paulina Vazquez | Peer Specialist | 4283 El Cajon Blvd Ste 115, San Diego, CA 92105-1289 | 2020-07-20 |
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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.