Provider Demographics
NPI:1396206348
Name:MANSOORI, JASMIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:
Last Name:MANSOORI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OHIO DR
Mailing Address - Street 2:SUITE 182
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:469-398-1972
Mailing Address - Fax:737-247-7483
Practice Address - Street 1:2301 OHIO DR
Practice Address - Street 2:SUITE 182
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-398-1972
Practice Address - Fax:737-247-7483
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3130213E00000X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery