Active NPI
Engella Samar Mansour, DDS
- Dentist
- San Diego, CA
National Provider Identifier
1871506360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 42615
- Practice address
- 1324 Garnet Ave
San Diego, CA 92109-3011 - Phone
- (619) 275-2750
- Fax
- (619) 275-1935
- NPI assigned
- Aug 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 42615 | CA | Primary |
Addresses
Primary practice location
1324 Garnet Ave
San Diego, CA 92109-3011
Mailing address
1324 Garnet Ave
San Diego, CA 92109-3011
Phone (619) 275-2750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42615 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470182400000",
"number": "1871506360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1324 GARNET AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921093011",
"telephone_number": "619-275-2750",
"fax_number": "619-275-1935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1324 GARNET AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921093011",
"telephone_number": "619-275-2750",
"fax_number": "619-275-1935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOUR",
"first_name": "ENGELLA",
"middle_name": "SAMAR",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-14",
"last_updated": "2016-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "42615",
"primary": true
}
],
"identifiers": [],
"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 Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.