Provider Demographics
NPI:1184762015
Name:MANSOURI, JELRIZA CLAIRE B (MD)
Entity type:Individual
Prefix:
First Name:JELRIZA CLAIRE
Middle Name:B
Last Name:MANSOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JELRIZA CLAIRE
Other - Middle Name:ILAGAN
Other - Last Name:BAYLOSIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39141 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5818
Mailing Address - Country:US
Mailing Address - Phone:510-248-1000
Mailing Address - Fax:510-608-6055
Practice Address - Street 1:2299 MOWRY AVE
Practice Address - Street 2:SUITE 3-C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1621
Practice Address - Country:US
Practice Address - Phone:510-248-1470
Practice Address - Fax:510-796-5198
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97750207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology