Provider Demographics
NPI:1902121429
Name:MANCUSO, APRIL (DO)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:MANCUSO
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1871 MARTIN AVE
Mailing Address - Street 2:NMCI MEDICAL CLINIC, INC
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050
Mailing Address - Country:US
Mailing Address - Phone:808-463-9234
Mailing Address - Fax:408-988-8585
Practice Address - Street 1:1871 MARTIN AVE
Practice Address - Street 2:NMCI MEDICAL CLINIC, INC
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050
Practice Address - Country:US
Practice Address - Phone:808-463-9234
Practice Address - Fax:408-988-8585
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010586208100000X
CA20A14006208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH419120Medicare PIN