Individual
PETER K MANSURIPUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
975 SERENO DR, VALLEJO, CA 94589
(707) 651-2549
Mailing address
975 SERENO DR, VALLEJO, CA 94589-2441
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
14894
RI
207X00000X
Orthopaedic Surgery Physician
LP01956
RI
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
A140883
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588984306
—
RI
Enumeration date
06/03/2010
Last updated
02/11/2022
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