Basic Information
| Provider Information | |||||||||
| NPI: | 1104840776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUSIF | ||||||||
| FirstName: | SHAFIK | ||||||||
| MiddleName: | RIZKALLA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4050 CORATINA WAY | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957428006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169853317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7400 SUNRISE BOULEVARD | ||||||||
| Address2: | MOLINA MEDICAL CENTERS | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956103011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167222725 | ||||||||
| FaxNumber: | 9167230142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | PA13951 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | PA13951 | 01 | CA | MEDI-CAL | OTHER |