MEDICARE: MS. KATARINA RADISAVLJEVIC MANSIR PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY25417	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB235234	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1457588998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATARINA RADISAVLJEVIC MANSIR PSY.D.

Provider Business Mailing Address
First Line	:	197 WOODLAND PKWY
Second Line	:	SUITE 104 PMB274
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-3020
Country	:	US
Telephone Number	:	858-465-9195
Fax Number	:	858-430-5265

Provider Business Practice Location Address
First Line	:	5190 GOVERNOR DR STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2848
Country	:	US
Telephone Number	:	858-465-9195
Fax Number	:	858-430-5265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	01/23/2026

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