Healthcare Provider Details

I. General information

NPI: 1275115263
Provider Name (Legal Business Name): KATHERINE MANSEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

74699 TECHNOLOGY DR APT 14105
PALM DESERT CA
92211-5833
US

V. Phone/Fax

Practice location:
  • Phone: 303-746-2545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number20A24748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: