Healthcare Provider Details

I. General information

NPI: 1144648908
Provider Name (Legal Business Name): NADIN MANSOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7392 MAGNOLIA AVE
RIVERSIDE CA
92504-3861
US

IV. Provider business mailing address

11980 MOUNT VERNON AVE
GRAND TERRACE CA
92313-5172
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3330
  • Fax:
Mailing address:
  • Phone: 909-864-1097
  • Fax: 951-487-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number140496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: