Provider Demographics
NPI:1477244341
Name:NOFAL, YUSEF
Entity Type:Individual
Prefix:
First Name:YUSEF
Middle Name:
Last Name:NOFAL
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 1:1089 W HUFF ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6826
Mailing Address - Country:US
Mailing Address - Phone:646-523-8208
Mailing Address - Fax:
Practice Address - Street 1:2496 1/2 N MACY ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-6597
Practice Address - Country:US
Practice Address - Phone:646-523-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3618812413104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness