Provider Demographics
NPI:1407404726
Name:YOUSEFI, GEORGE K
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:K
Last Name:YOUSEFI
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 1:3630 CONTOUR PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6596
Mailing Address - Country:US
Mailing Address - Phone:847-372-5967
Mailing Address - Fax:
Practice Address - Street 1:48 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2928
Practice Address - Country:US
Practice Address - Phone:559-665-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist