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General NPI Number Information
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NPI Number | 1902685704
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Entity Type | Individual
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Provider Name | JENNIFER REBECCA MANSOOR
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 26284 OSO RD
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1629
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Country | US
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Telephone | 949-842-9557
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Fax |
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Provider Business Mailing Address
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Address Line | 2847 PENASCO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3560
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Country | US
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Telephone | 949-842-5178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | RPE-18232
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License Number State | CA
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