Provider Demographics
NPI:1982620647
Name:MOHEB S YOUSSEF M D INC
Entity type:Organization
Organization Name:MOHEB S YOUSSEF M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHEB
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-883-7243
Mailing Address - Street 1:5730 GLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1713
Mailing Address - Country:US
Mailing Address - Phone:626-201-4853
Mailing Address - Fax:909-392-1396
Practice Address - Street 1:5730 GLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1713
Practice Address - Country:US
Practice Address - Phone:626-201-4853
Practice Address - Fax:909-392-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42256207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422560Medicaid
CAA42256Medicare PIN