Provider Demographics
NPI:1649531625
Name:ARAIN, MANSOOR AMJAD (MD)
Entity type:Individual
Prefix:
First Name:MANSOOR
Middle Name:AMJAD
Last Name:ARAIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S STRATFORD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5901
Mailing Address - Country:US
Mailing Address - Phone:805-928-5767
Mailing Address - Fax:805-349-0222
Practice Address - Street 1:206 S STRATFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5901
Practice Address - Country:US
Practice Address - Phone:805-928-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100854207R00000X, 208000000X, 390200000X
CAA172489208000000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program