Healthcare Provider Details

I. General information

NPI: 1891619243
Provider Name (Legal Business Name): YERANUHI MARY MANSOURIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 OVERLAND AVE STE 108
CULVER CITY CA
90230-4969
US

IV. Provider business mailing address

5000 OVERLAND AVE STE 108
CULVER CITY CA
90230-4969
US

V. Phone/Fax

Practice location:
  • Phone: 310-502-1603
  • Fax:
Mailing address:
  • Phone: 310-280-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: