Provider Demographics
NPI:1194848580
Name:YACOUB, NADER MICHEL (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:MICHEL
Last Name:YACOUB
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 1:14282 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-2162
Mailing Address - Country:US
Mailing Address - Phone:626-917-4481
Mailing Address - Fax:626-917-4462
Practice Address - Street 1:14282 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-2162
Practice Address - Country:US
Practice Address - Phone:626-917-4481
Practice Address - Fax:626-917-4462
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40916207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine