Provider Demographics
NPI:1699433268
Name:YACOUBI, OUSSAMA
Entity type:Individual
Prefix:
First Name:OUSSAMA
Middle Name:
Last Name:YACOUBI
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 1:715 N VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2721
Mailing Address - Country:US
Mailing Address - Phone:571-276-2898
Mailing Address - Fax:
Practice Address - Street 1:3261 THEODORE R HAGAN
Practice Address - Street 2:S DRIVE N.E
Practice Address - City:DISTRICT OF COLUMBIA
Practice Address - State:DC
Practice Address - Zip Code:20018-2001
Practice Address - Country:US
Practice Address - Phone:407-948-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant