Provider Demographics
NPI:1942270319
Name:YOUSEF, SALAH (CRNA)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:
Last Name:YOUSEF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31625 DE PORTOLA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2770
Mailing Address - Country:US
Mailing Address - Phone:951-501-4200
Mailing Address - Fax:951-900-3108
Practice Address - Street 1:31625 DE PORTOLA RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2770
Practice Address - Country:US
Practice Address - Phone:951-501-4200
Practice Address - Fax:951-900-3108
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123790367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA90333OtherFALLON
P00096823OtherRAILROAD
MA90333OtherFALLON