Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G45657 | CA |
NPI | 1245255306 |
---|---|
Provider Name | Dr. Sylvia S. Mansour |
First Address | Torrance, CA 90503-4352 |
Second Address | Torrance, CA 90503-4352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G456570 | (05) | CA |
A50134 | (02) | CA |