Provider Demographics
NPI:1740339894
Name:YACOUB, ATEF LABIB (MD)
Entity type:Individual
Prefix:DR
First Name:ATEF
Middle Name:LABIB
Last Name:YACOUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2199
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-8099
Mailing Address - Country:US
Mailing Address - Phone:323-726-0533
Mailing Address - Fax:323-726-0274
Practice Address - Street 1:126 S MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4730
Practice Address - Country:US
Practice Address - Phone:323-720-9204
Practice Address - Fax:323-720-9208
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40189208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0070630Medicaid
CAGR0070010Medicaid
CAW10317Medicare PIN
CAW13112Medicare PIN