Provider Demographics
NPI:1942731930
Name:MANSOR, RIAD
Entity type:Individual
Prefix:
First Name:RIAD
Middle Name:
Last Name:MANSOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 S MONACO PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1907
Mailing Address - Country:US
Mailing Address - Phone:720-999-1314
Mailing Address - Fax:
Practice Address - Street 1:3801 E FLORIDA AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2538
Practice Address - Country:US
Practice Address - Phone:303-466-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor