Provider Demographics
NPI:1518342294
Name:AL MANSURI, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AL MANSURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3860
Mailing Address - Country:US
Mailing Address - Phone:602-299-3330
Mailing Address - Fax:602-252-2066
Practice Address - Street 1:505 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3860
Practice Address - Country:US
Practice Address - Phone:602-299-3330
Practice Address - Fax:602-252-2066
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver