Provider Demographics
NPI:1912224189
Name:MARK YOUSSEF MD. INC.
Entity Type:Organization
Organization Name:MARK YOUSSEF MD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-3552
Mailing Address - Street 1:275 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4893
Mailing Address - Country:US
Mailing Address - Phone:626-796-3552
Mailing Address - Fax:626-796-3552
Practice Address - Street 1:275 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4893
Practice Address - Country:US
Practice Address - Phone:626-796-3552
Practice Address - Fax:626-796-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497930Medicaid
CA00A497930Medicaid
CAF174495Medicare UPIN