Healthcare Provider Details

I. General information

NPI: 1184565814
Provider Name (Legal Business Name): INTERNAL MEDICINE AND PEDIATRICS OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 AERO DR STE 106
SAN DIEGO CA
92123-1763
US

IV. Provider business mailing address

8745 AERO DR STE 106
SAN DIEGO CA
92123-1763
US

V. Phone/Fax

Practice location:
  • Phone: 858-204-2152
  • Fax: 844-749-3849
Mailing address:
  • Phone: 858-204-2152
  • Fax: 844-749-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARIM MANSOUR
Title or Position: PRESIDENT
Credential: MD
Phone: 858-204-2152