Basic Information
| Provider Information | |||||||||
| NPI: | 1508178088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANSURI | ||||||||
| FirstName: | SARFARAZ | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13737 NOEL RD | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752401374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147122728 | ||||||||
| FaxNumber: | 8665811184 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 MURRAY AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934051806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055467600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2010 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A132746 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A132746 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | A132746 | 01 | CA | MEDICAL BOARD PHYSICIAN LICENSE | OTHER |