Healthcare Provider Details

I. General information

NPI: 1154004596
Provider Name (Legal Business Name): KAREN MANSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

IV. Provider business mailing address

26050 SHADY GLEN ST
MURRIETA CA
92563-6330
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-1125
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax: 619-374-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: