Basic Information
| Provider Information | |||||||||
| NPI: | 1750027546 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAHTAB K YOUSEFI, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 E 17TH ST # F249 | ||||||||
| Address2: | |||||||||
| 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: | 9496242734 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2022 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | YOUSEFI | ||||||||
| AuthorizedOfficialFirstName: | MAHTAB | ||||||||
| AuthorizedOfficialMiddleName: | KARKHANE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9495709415 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.