Healthcare Provider Details

I. General information

NPI: 1447869144
Provider Name (Legal Business Name): TARAB MANSOOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5620 1 UNIVERSITY OF NEW MEXICO ALBUQUERQUE NM
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1303 E HERNDON AVE
FRESNO CA
93720-3309
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3342
  • Fax:
Mailing address:
  • Phone: 559-450-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA197656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: