Provider Demographics
NPI:1639635204
Name:YOUSEFI, DALAR
Entity Type:Individual
Prefix:
First Name:DALAR
Middle Name:
Last Name:YOUSEFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26639 VALLEY CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2376
Mailing Address - Country:US
Mailing Address - Phone:661-254-1842
Mailing Address - Fax:661-254-1862
Practice Address - Street 1:26639 VALLEY CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-2376
Practice Address - Country:US
Practice Address - Phone:661-254-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2960162251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics