Provider Demographics
NPI:1265463194
Name:MANSFIELD, PERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 CAMINO DEL RIO N 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1716
Mailing Address - Country:US
Mailing Address - Phone:619-810-1111
Mailing Address - Fax:
Practice Address - Street 1:3590 CAMINO DEL RIO N 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1716
Practice Address - Country:US
Practice Address - Phone:619-810-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47905207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A479050Medicaid
CAA47905Medicare ID - Type Unspecified
CAF59568Medicare UPIN