Healthcare Provider Details

I. General information

NPI: 1174446033
Provider Name (Legal Business Name): ALTERRA ANESTHESIA APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 ROSCOE BLVD
PANORAMA CITY CA
91402-4618
US

IV. Provider business mailing address

263 W OLIVE AVE STE 213
BURBANK CA
91502-1825
US

V. Phone/Fax

Practice location:
  • Phone: 818-929-8130
  • Fax:
Mailing address:
  • Phone: 818-929-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHON MANSOUR
Title or Position: CEO
Credential: DO
Phone: 818-929-8130