Basic Information
| Provider Information | |||||||||
| NPI: | 1235188400 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YOUSSEF | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4551 GLENCOE AVE | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103012030 | ||||||||
| FaxNumber: | 3103065247 | ||||||||
| Practice Location | |||||||||
| Address1: | 15248 11TH ST | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923953704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602458691 | ||||||||
| FaxNumber: | 7608436020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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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 | 207P00000X | A49793 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A497930 | 05 | CA | MEDICAID |