Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | ME 107848 | FL |
NPI | 1356655187 |
---|---|
Provider Name | Omer Mansoor |
First Address | Coral Gables, FL 33146-2423 |
Second Address | West Palm Beach, FL 33407-2452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 07/10/2014 |