Provider Demographics
NPI:1922286244
Name:MAKABIS YOUSEFPOUR DPM
Entity Type:Organization
Organization Name:MAKABIS YOUSEFPOUR DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKABIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-262-7450
Mailing Address - Street 1:2137 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1843
Mailing Address - Country:US
Mailing Address - Phone:323-262-7450
Mailing Address - Fax:323-262-2337
Practice Address - Street 1:2137 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1843
Practice Address - Country:US
Practice Address - Phone:323-262-7450
Practice Address - Fax:323-262-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4609332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5501590001Medicare NSC
CAE4609Medicare PIN