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Organization
MEDHAT N. MANSOUR, M.D. INC.
Active
Organization
MEDHAT N. MANSOUR, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEDHAT MANSOUR M.D. (PRESIDENT)
(213) 483-1007
Entity
Organization
Contact information
Practice address
2105 BEVERLY BLVD, SUITE 207, LOS ANGELES, CA 90057-2216
(213) 483-1007
(213) 483-3207
Mailing address
2105 BEVERLY BLVD, SUITE 207, LOS ANGELES, CA 90057-2216
(213) 483-1007
(213) 483-3207
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A24055
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A240550
—
CA
01
—
05D0943499
CLIA NUMBER
CA
01
—
A24055
MEDICAL LICENSE NUMBER
CA
Enumeration date
02/27/2007
Last updated
02/05/2010
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