Basic Information
| Provider Information | |||||||||
| NPI: | 1649613753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUSEFI | ||||||||
| FirstName: | MAHTAB | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 E 17TH ST | ||||||||
| Address2: | # F249 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926273201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495709415 | ||||||||
| FaxNumber: | 9495709413 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 VICTORIA ST | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926271995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496422734 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.