Healthcare Provider Details

I. General information

NPI: 1205802907
Provider Name (Legal Business Name): MANSOOR JAVEED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 CREEKSIDE DR
FOLSOM CA
95630
US

IV. Provider business mailing address

740 OAK AVENUE PKWY STE 110
FOLSOM CA
95630-6814
US

V. Phone/Fax

Practice location:
  • Phone: 916-250-0377
  • Fax:
Mailing address:
  • Phone: 916-250-0377
  • Fax: 916-250-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA49861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: