Basic Information
| Provider Information | |||||||||
| NPI: | 1053787366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GHOZLAND AND YOUSSEF A MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 893520 | ||||||||
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| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925893520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104340044 | ||||||||
| FaxNumber: | 3104340099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 OCEAN AVE | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904012108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104340044 | ||||||||
| FaxNumber: | 3104340099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 08/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | YOUSEFF | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3104340044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.