Provider Demographics
NPI:1679668420
Name:MANSOUR, JOSEPH SAMMY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAMMY
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:SAMI
Other - Last Name:MANSOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:1401 SPANOS CT STE 230
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2816
Practice Address - Country:US
Practice Address - Phone:209-550-4720
Practice Address - Fax:209-572-2923
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34244207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27420Medicare UPIN