# FRED AND MARY MANSUBI, M.D. A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114126034
- **Authorized official:** MRS. MEHRI (MARY) MANSUBI M.D. (OWNER)
- **Authorized official phone:** (408) 358-2627

## Contact information

- **Practice address:** 2577 SAMARITAN DR, SUITE 860, SAN JOSE, CA 95124-4100
- **Practice address phone:** (408) 358-2627
- **Practice address fax:** (408) 356-6445
- **Mailing address:** 2577 SAMARITAN DR, SUITE 860, SAN JOSE, CA 95124-4100
- **Mailing address phone:** (408) 358-2627
- **Mailing address fax:** (408) 356-6445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | A330510 | CA | — |
| 2080P0201X | Pediatric Allergy/Immunology Physician | A262890 | CA | Yes |

## Other

- **Enumeration date:** 07/11/2007
- **Last updated:** 03/06/2013