Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A86841 | CA |
N | 111NI0900X | Internist | A86841 | CA |
Y | 207RR0500X | Rheumatology | A86841 | CA |
NPI | 1073597241 |
---|---|
Provider Name | Dr. Mark Mansour |
First Address | San Francisco, CA 94145-0680 |
Second Address | Cameron Park, CA 95682-8276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 12/10/2015 |