Provider Demographics
NPI:1518520972
Name:MANSOUR, MUHAMMAD SABER (ND)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SABER
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 CHERRY AVE STE 27
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2954
Mailing Address - Country:US
Mailing Address - Phone:215-909-1394
Mailing Address - Fax:
Practice Address - Street 1:311 OAK STREET SUITE C2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:215-909-1394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1800175F00000X
CAND1063175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath