Provider Demographics
NPI:1245255306
Name:MANSOUR, SYLVIA S (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:S
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-214-2213
Mailing Address - Fax:310-370-1590
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-214-2213
Practice Address - Fax:310-370-1590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG456572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G456570Medicaid
CAA50134Medicare UPIN