NPIMap

Organization Active NPI

Medhat N. Mansour, M.D. Inc.

  • Specialist
  • Los Angeles, CA
National Provider Identifier
1992832810
Registry record updated Feb 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A24055 Issued in CA
Legal business name
MEDHAT N. MANSOUR, M.D. INC.
Practice address
2105 Beverly Blvd
Suite 207
Los Angeles, CA 90057-2216
Phone
(213) 483-1007
Fax
(213) 483-3207
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Medhat Mansour, M.D.
Title
President
Phone
(213) 483-1007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A24055 CA Primary

Addresses

Primary practice location

2105 Beverly Blvd
Suite 207
Los Angeles, CA 90057-2216

Mailing address

2105 Beverly Blvd
Suite 207
Los Angeles, CA 90057-2216
Phone (213) 483-1007

Other identifiers 3

IdentifierTypeStateIssuer
A24055OtherCAMEDICAL LICENSE NUMBER
00A240550MedicaidCA
05D0943499OtherCACLIA NUMBER

National Provider Directory

National Provider Directory

Locations

2105 Beverly Blvd
Ste 207
Los Angeles, CA 90057
Phone (213) 483-1007

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1992832810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "address_2": "SUITE 207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-483-1007",
            "fax_number": "213-483-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "address_2": "SUITE 207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-483-1007",
            "fax_number": "213-483-3207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDHAT N. MANSOUR, M.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "MEDHAT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-483-1007",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A24055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "A24055",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A240550",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "05D0943499",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.