Provider Demographics
NPI:1760415855
Name:YAZBECK, MOUSSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUSSA
Middle Name:
Last Name:YAZBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 MONTEGO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2990
Mailing Address - Country:US
Mailing Address - Phone:925-937-0404
Mailing Address - Fax:925-937-1340
Practice Address - Street 1:1601 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3122
Practice Address - Country:US
Practice Address - Phone:925-937-0404
Practice Address - Fax:925-937-1340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3824207R00000X
CAA87574207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150250001Medicaid
OK200021000AMedicaid
AR5M633OtherAR BCBS
H90625Medicare UPIN
AR150250001Medicaid