Provider Demographics
NPI:1609333764
Name:YOUNIS, REHAM (RDO)
Entity Type:Individual
Prefix:
First Name:REHAM
Middle Name:
Last Name:YOUNIS
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 BEACH BLVD # 235
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1608
Mailing Address - Country:US
Mailing Address - Phone:310-741-0054
Mailing Address - Fax:949-608-8202
Practice Address - Street 1:10401 BEACH BLVD # 235
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-1608
Practice Address - Country:US
Practice Address - Phone:310-741-0054
Practice Address - Fax:949-608-8202
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEDO70859156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RDO070859OtherTHE CALIFORNIA STATE BOARD OF OPTOMETRY