Healthcare Provider Details

I. General information

NPI: 1679668420
Provider Name (Legal Business Name): JOSEPH SAMMY MANSOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH SAMI MANSOUR MD

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS CT STE 230
MODESTO CA
95355-2816
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-4720
  • Fax: 209-572-2923
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA34244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: