Provider Demographics
NPI:1942721527
Name:YUSIM, RICHARD ALAN
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:YUSIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2539
Mailing Address - Country:US
Mailing Address - Phone:805-765-0674
Mailing Address - Fax:
Practice Address - Street 1:250 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2539
Practice Address - Country:US
Practice Address - Phone:562-760-5413
Practice Address - Fax:562-760-5413
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XOtherPHILLIPS GRADUATE UNIVERSITY