Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 161543 | CA |
Y | 207V00000X | Obstetrician & Gynecologist | 63542 | AZ |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | R78909 | AZ |
NPI | 1811428774 |
---|---|
Provider Name | Trina Mansour |
First Address | Scottsdale, AZ 85259-5452 |
Second Address | Scottsdale, AZ 85259-5452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 13/08/2021 |