Basic Information
| Provider Information | |||||||||
| NPI: | 1477064079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANSILLA | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MA, MPA, ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3136 HACIENDA DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945192240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164284873 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2000 SIERRA ROAD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253632000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2017 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW85216 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.