Provider Demographics
NPI:1952375768
Name:YACOUB, ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
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 1:2635 G ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2813
Mailing Address - Country:US
Mailing Address - Phone:661-633-2300
Mailing Address - Fax:
Practice Address - Street 1:3001 SILLECT AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:661-316-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48080207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A480801Medicaid
CAP00223524OtherRAILROAD MEDICARE
E78219Medicare UPIN
CA00A480801Medicare ID - Type Unspecified