Provider Demographics
NPI:1639498694
Name:YAGOUB, ABDELAZIZ M (MS ABA)
Entity Type:Individual
Prefix:MR
First Name:ABDELAZIZ
Middle Name:M
Last Name:YAGOUB
Suffix:
Gender:M
Credentials:MS ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9243 JAMISON AVE
Mailing Address - Street 2:# B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4282
Mailing Address - Country:US
Mailing Address - Phone:267-259-9388
Mailing Address - Fax:
Practice Address - Street 1:9243 JAMISON AVE
Practice Address - Street 2:# B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4282
Practice Address - Country:US
Practice Address - Phone:267-259-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst