Healthcare Provider Details

I. General information

NPI: 1932037942
Provider Name (Legal Business Name): MOHAMAD DEYA'ALDIN ABDALAH ALMANSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 GOODWOOD BLVD SUITE 202 PAC/PEDIATRIC ACADEMIC CLINIC
BATON ROUGE LA
70806
US

IV. Provider business mailing address

8300 CONSTANTIN BLVD 2ND FLOOR ADMINISTRATION, PRP OFFICE
BATON ROUGE LA
70809
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8013
  • Fax: 225-765-2033
Mailing address:
  • Phone: 225-374-1317
  • Fax: 225-374-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: