Healthcare Provider Details

I. General information

NPI: 1225590375
Provider Name (Legal Business Name): NAYLA MANSOOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE 305
PHOENIX AZ
85027-4027
US

IV. Provider business mailing address

20401 N 73RD ST STE 230
SCOTTSDALE AZ
85255-4153
US

V. Phone/Fax

Practice location:
  • Phone: 480-556-0446
  • Fax: 480-556-0447
Mailing address:
  • Phone: 480-556-0446
  • Fax: 480-556-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7703
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: