Provider Demographics
NPI:1053987628
Name:MANSARAY, ABDUL KARIM
Entity type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:KARIM
Last Name:MANSARAY
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 1:225 S 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8336
Mailing Address - Country:US
Mailing Address - Phone:623-466-2660
Mailing Address - Fax:
Practice Address - Street 1:1990 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3462
Practice Address - Country:US
Practice Address - Phone:623-295-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QD1600X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities