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General NPI Number Information
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NPI Number | 1386184620
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Entity Type | Organization
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Legal Business Name | SAPOORA MANSHAII MD INC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/09/2024
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Provider Practice Location Address
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Address Line | 400 N MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-2339
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Country | US
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Telephone | 707-778-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 EXETER SQUARE LN
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City | SACRAMENTO
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State | CA
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Zip | 95825-6476
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Country | US
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Telephone | 916-862-1819
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Fax | 916-224-3840
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DR. SAPOORA MANSHAII
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Credential | M.D.
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Telephone | 916-862-1819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | C54919
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C54919
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License Number State | CA
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