Provider Demographics
NPI:1366882441
Name:MANSOOR, RABEEA (MD)
Entity type:Individual
Prefix:
First Name:RABEEA
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 1:3643 S STAPLES ST STE B
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2456
Mailing Address - Country:US
Mailing Address - Phone:361-694-1550
Mailing Address - Fax:361-808-2766
Practice Address - Street 1:3643 S STAPLES ST STE B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-694-1550
Practice Address - Fax:361-808-2766
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR00702084P0804X
OH57.0224982084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381489901Medicaid