Healthcare Provider Details

I. General information

NPI: 1538166418
Provider Name (Legal Business Name): KHALIFA MANSOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8043 2ND ST STE 105
DOWNEY CA
90241-3621
US

IV. Provider business mailing address

8043 2ND ST STE 105
DOWNEY CA
90241-3621
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-1134
  • Fax: 562-861-9895
Mailing address:
  • Phone: 562-862-1134
  • Fax: 562-861-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA47873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: