Provider Demographics
NPI:1467981340
Name:FOURIE, KAREN YBERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:YBERICO
Last Name:FOURIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 WHITTIER BLVD LOS ANGELES, CA 90023
Mailing Address - Street 2:
Mailing Address - City:BOYLE HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90023
Mailing Address - Country:US
Mailing Address - Phone:541-728-1077
Mailing Address - Fax:
Practice Address - Street 1:3945 WHITTIER BLVD LOS ANGELES
Practice Address - Street 2:
Practice Address - City:BOYLE HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:90023-4433
Practice Address - Country:US
Practice Address - Phone:541-728-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165344207Q00000X
CAA163544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine