Healthcare Provider Details

I. General information

NPI: 1639157720
Provider Name (Legal Business Name): JEYLAN A EL-MANSOURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5871 W CRAIG RD
LAS VEGAS NV
89130-2575
US

IV. Provider business mailing address

5871 W CRAIG RD
LAS VEGAS NV
89130-2575
US

V. Phone/Fax

Practice location:
  • Phone: 702-724-2020
  • Fax: 702-724-2800
Mailing address:
  • Phone: 702-724-2020
  • Fax: 702-724-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18817
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD058408L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: