Provider Demographics
NPI:1174021729
Name:DR. RUMANA MANSUR AND ASSOCIATES, A PROFESSIONAL PSYCHOLOGICAL CORPORA
Entity Type:Organization
Organization Name:DR. RUMANA MANSUR AND ASSOCIATES, A PROFESSIONAL PSYCHOLOGICAL CORPORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:657-223-3360
Mailing Address - Street 1:4000 MACARTHUR BLVD STE 600
Mailing Address - Street 2:EAST TOWER
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 MACARTHUR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2517
Practice Address - Country:US
Practice Address - Phone:657-223-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty