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General NPI Number Information
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NPI Number | 1023493459
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Entity Type | Organization
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Legal Business Name | HADI MANSOURY MD INC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 04/14/2024
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Provider Practice Location Address
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Address Line | 23521 PASEO DE VALENCIA STE 108
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3137
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Country | US
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Telephone | 949-396-1389
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Fax | 949-625-7532
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Provider Business Mailing Address
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Address Line | PO BOX 2684
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City | MISSION VIEJO
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State | CA
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Zip | 92690-0684
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Country | US
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Telephone | 949-380-1389
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HADI MANSOURY
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Credential | MD
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Telephone | 949-396-1389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A89057
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License Number State | CA
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