Individual
THAGHAR MANSOUR ODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1111 W CHASE AVE, EL CAJON, CA 92020-5710
(619) 515-2499
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
NPF95000205
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
95000205
CA
Other
Enumeration date
02/03/2014
Last updated
01/05/2021
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