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NPI Code Detail

MEDICARE: MANELI MASOUMEH MANSOORI M.D.

MEDICARE: MANELI MASOUMEH MANSOORI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA103803CA
2282N00000XGeneral Acute Care HospitalA103803CA

General Provider Information

NPI Number : 1669648739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANELI MASOUMEH MANSOORI M.D.
Provider Business Mailing Address
First Line : 11027 BURBANK BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91601-2431
Country : US
Telephone Number : 818-985-8323
Fax Number :
Provider Business Practice Location Address
First Line : 11027 BURBANK BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91601-2431
Country : US
Telephone Number : 818-985-8323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2008
Last Update Date : 09/04/2025

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