Provider Demographics
NPI:1558483487
Name:MANSOURI, SHAHLA (FNP,MSN,MPH)
Entity Type:Individual
Prefix:MRS
First Name:SHAHLA
Middle Name:
Last Name:MANSOURI
Suffix:
Gender:F
Credentials:FNP,MSN,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 NEWELL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3106
Mailing Address - Country:US
Mailing Address - Phone:951-686-6998
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA
Practice Address - Street 2:CAMPUS HEALTH CENTER
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92521-0001
Practice Address - Country:US
Practice Address - Phone:951-827-7186
Practice Address - Fax:951-827-3133
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily