Healthcare Provider Details

I. General information

NPI: 1427827542
Provider Name (Legal Business Name): NADIN MANSOUR, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2023
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

7392 MAGNOLIA AVE
RIVERSIDE CA
92504-3861
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3330
  • Fax: 877-216-0436
Mailing address:
  • Phone: 951-352-3330
  • Fax: 877-216-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NADIN MANSOUR
Title or Position: MD
Credential: MD
Phone: 361-765-0798