Provider Demographics
NPI:1811155328
Name:CRESCENT PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:CRESCENT PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-487-1560
Mailing Address - Street 1:32667 KENITA WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3001
Mailing Address - Country:US
Mailing Address - Phone:510-487-1560
Mailing Address - Fax:
Practice Address - Street 1:32667 KENITA WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3001
Practice Address - Country:US
Practice Address - Phone:510-487-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC528592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty