LEE CHAIDEZ MANCILLA

SANTA MONICA, CA
NPI1356526495
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: CA  PA19534)
Additional Taxonomies363AM0700X Physician Assistant, Medical
(Licence: CA  19534)
Enumeration Date2008-01-08
Last Update Date2010-08-17
Business Address
-- LEE CHAIDEZ MANCILLA PA-C
1711 OCEAN PARK BLVD
SANTA MONICA, CA 90405-4901
Phone number: 310-450-4773
Mailing Address
-- LEE CHAIDEZ MANCILLA PA-C
1711 OCEAN PARK BLVD
SANTA MONICA, CA 90405-4901
Phone number: 310-450-4773