Lara Dia Mansour, DO is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Fontana, California. Her current practice location is
17234 Valley Blvd, Building A, Fontana, California. You can reach out to her office (for appointments etc.) via phone at
(833) 574-2273.
Lara Dia Mansour is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1780264770.
Physician's Profile
Full Name | Lara Dia Mansour |
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Gender | Female |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 17234 Valley Blvd, Fontana, California |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1780264770
- Provider Enumeration Date: 04/13/2021
- Last Update Date: 08/02/2023
Medicare PECOS Information:
- PECOS PAC ID: 1759742125
- Enrollment ID: I20230801003739
Medical Identifiers
Medical identifiers for Lara Dia Mansour such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1780264770 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2084P0800X | Psychiatry & Neurology - Psychiatry | 20466 (California) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lara Dia Mansour is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Lara Dia Mansour, DO 17234 Valley Blvd, Building A, Fontana, CA 92335-6720 Ph: () - | Lara Dia Mansour, DO 17234 Valley Blvd, Building A, Fontana, CA 92335-6720 Ph: (833) 574-2273 |
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