Provider Demographics
NPI:1285645606
Name:YACOUB, EMILE IGNATIUS (DPT OCS CSCS)
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:IGNATIUS
Last Name:YACOUB
Suffix:
Gender:M
Credentials:DPT OCS CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3330
Mailing Address - Country:US
Mailing Address - Phone:951-735-6060
Mailing Address - Fax:951-735-4510
Practice Address - Street 1:341 MAGNOLIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3330
Practice Address - Country:US
Practice Address - Phone:951-735-6060
Practice Address - Fax:951-735-4510
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT255730OtherBLUE CROSS
CA0PT255730OtherBLUE SHIELD
CA0PT255730Medicare PIN
CA0PT255730OtherBLUE CROSS