Provider Demographics
NPI:1750471892
Name:YAAQOUBI, SAID (LMP)
Entity Type:Individual
Prefix:
First Name:SAID
Middle Name:
Last Name:YAAQOUBI
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 HWY 99
Mailing Address - Street 2:SIUTE150
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8047
Mailing Address - Country:US
Mailing Address - Phone:425-774-2636
Mailing Address - Fax:425-774-2688
Practice Address - Street 1:21600 HWY 99
Practice Address - Street 2:SIUTE150
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8047
Practice Address - Country:US
Practice Address - Phone:425-774-2636
Practice Address - Fax:425-774-2688
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018785225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0208570OtherL/I