Provider Demographics
NPI:1891325312
Name:YUSUF, LEILA
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:YUSUF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 GOLF CLUB DR APT 4304
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5879
Mailing Address - Country:US
Mailing Address - Phone:706-358-7622
Mailing Address - Fax:
Practice Address - Street 1:4315 GOLF CLUB DR APT 4304
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5879
Practice Address - Country:US
Practice Address - Phone:706-358-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12681390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program