Active NPI
Katarina Radisavljevic Mansir, PSY.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1457588998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY25417
- Practice address
- 5190 Governor Dr Ste 104
San Diego, CA 92122-2848 - Phone
- (858) 465-9195
- Fax
- (858) 430-5265
- NPI assigned
- Jun 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY25417 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
5190 Governor Dr Ste 104
San Diego, CA 92122-2848
Mailing address
197 Woodland Pkwy
Suite 104 Pmb274
San Marcos, CA 92069-3020
Phone (858) 465-9195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CB235234 | Other | CA | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150624001560 | CA | Practitioner - Psychologist Billing Independently | 8123339652 | Practice locations: San Diego, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY25417 | CA | MD | Clinical Psychologist |
| 25417 | CA | MD | Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1457588998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "197 WOODLAND PKWY",
"address_2": "SUITE 104 PMB274",
"city": "SAN MARCOS",
"state": "CA",
"postal_code": "920693020",
"telephone_number": "858-465-9195",
"fax_number": "858-430-5265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5190 GOVERNOR DR STE 104",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921222848",
"telephone_number": "858-465-9195",
"fax_number": "858-430-5265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSIR",
"first_name": "KATARINA",
"middle_name": "RADISAVLJEVIC",
"name_prefix": "Ms.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-11",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY25417",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "CB235234",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.