Provider Demographics
NPI:1659391258
Name:ANDRE YOUSEFIA, M.D., INC.
Entity Type:Organization
Organization Name:ANDRE YOUSEFIA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-230-2333
Mailing Address - Street 1:1336 N MOORPARK RD
Mailing Address - Street 2:#288
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5224
Mailing Address - Country:US
Mailing Address - Phone:805-230-2333
Mailing Address - Fax:805-230-2335
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-230-2333
Practice Address - Fax:805-230-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH27752Medicare UPIN