Provider Demographics
NPI:1588076343
Name:MANSOOR, AMBER (MD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MANSOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CYPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1613
Mailing Address - Country:US
Mailing Address - Phone:405-550-3712
Mailing Address - Fax:
Practice Address - Street 1:16007 VIA SHAVANO STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2359
Practice Address - Country:US
Practice Address - Phone:210-492-1666
Practice Address - Fax:210-615-9400
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10049508390200000X
TXS11762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program