Healthcare Provider Details

I. General information

NPI: 1154439826
Provider Name (Legal Business Name): MANSOUR TAFRESHI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 BROCKTON AVE STE 108
RIVERSIDE CA
92501-3442
US

IV. Provider business mailing address

26322 CANNES CIR
MISSION VIEJO CA
92692-5215
US

V. Phone/Fax

Practice location:
  • Phone: 949-355-4226
  • Fax:
Mailing address:
  • Phone: 949-355-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number24004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: