Provider Demographics
NPI:1326529751
Name:MANSOUR, RANA
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 MATULA DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4005
Mailing Address - Country:US
Mailing Address - Phone:310-801-6062
Mailing Address - Fax:
Practice Address - Street 1:16200 VENTURA BLVD STE 409
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4699
Practice Address - Country:US
Practice Address - Phone:310-801-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18158OtherCALIFORNIA ACUPUNCTURE BOARD