Provider Demographics
NPI:1083876643
Name:YOUSSEFI, LENORE REEVA CS (MD)
Entity Type:Individual
Prefix:
First Name:LENORE REEVA
Middle Name:CS
Last Name:YOUSSEFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LENORE REEVA
Other - Middle Name:C
Other - Last Name:SIMANGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2575 E. BIDWELL STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-817-3700
Practice Address - Fax:916-817-3721
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17235208000000X
CAA121519208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics