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NPI Code Detail

MEDICARE: DR. KIMIA MANSOOR PSYD

MEDICARE: DR. KIMIA MANSOOR PSYD
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
1103TC0700XClinical Psychologist33524CA

General Provider Information

NPI Number : 1861916025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMIA MANSOOR PSYD
Provider Business Mailing Address
First Line : 2154 BRODERICK ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-1628
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2154 BRODERICK ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-1628
Country : US
Telephone Number : 510-858-1805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2017
Last Update Date : 04/08/2024

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