Provider Demographics
NPI:1215900956
Name:YOUSSEF, MOHEB S (M D)
Entity type:Individual
Prefix:DR
First Name:MOHEB
Middle Name:S
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5730 GLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1713
Mailing Address - Country:US
Mailing Address - Phone:909-392-9480
Mailing Address - Fax:909-392-1396
Practice Address - Street 1:5730 GLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1713
Practice Address - Country:US
Practice Address - Phone:909-392-9480
Practice Address - Fax:909-392-1396
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42256207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422560Medicaid
308-585-9OtherECFMG
CAA42256Medicare PIN
CA00A422560Medicaid