Provider Demographics
NPI:1992735930
Name:YOUSEFIA, ANDRE S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:S
Last Name:YOUSEFIA
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 1:1336 N MOORPARK RD # 288
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5224
Mailing Address - Country:US
Mailing Address - Phone:805-230-2333
Mailing Address - Fax:805-230-2335
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-230-2333
Practice Address - Fax:805-230-2335
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH27752Medicare UPIN