Provider Demographics
NPI:1285749937
Name:HADWEH, YOUSSEF BOULOS (MD)
Entity type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:BOULOS
Last Name:HADWEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-2820
Mailing Address - Country:US
Mailing Address - Phone:559-665-0275
Mailing Address - Fax:559-665-7126
Practice Address - Street 1:129 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2820
Practice Address - Country:US
Practice Address - Phone:559-665-0275
Practice Address - Fax:559-665-7126
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP53925FMedicaid
CA00G745360Medicaid
CA00G745360OtherALL PRIVATE INSURANCES
CA770431470OtherTAX ID
CA05D0921369OtherCLIA CERTIFICATION
CA05D0921369OtherCLIA CERTIFICATION
CA00G745360OtherALL PRIVATE INSURANCES
CA00G745360Medicaid