Provider Demographics
NPI:1083168983
Name:YUSUF, MOHAMED OMAR
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:OMAR
Last Name:YUSUF
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 1:4252 VAN DYKE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1255
Mailing Address - Country:US
Mailing Address - Phone:619-569-0463
Mailing Address - Fax:619-354-5217
Practice Address - Street 1:4252 VAN DYKE AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1255
Practice Address - Country:US
Practice Address - Phone:619-569-0463
Practice Address - Fax:619-354-5217
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor