Basic Information
| Provider Information | |||||||||
| NPI: | 1760415855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAZBECK | ||||||||
| FirstName: | MOUSSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1455 MONTEGO | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259370404 | ||||||||
| FaxNumber: | 9259371340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 YGNACIO VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259370404 | ||||||||
| FaxNumber: | 9259371340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 11/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E3824 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | A87574 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 150250001 | 05 | AR | MEDICAID | 200021000A | 05 | OK | MEDICAID | 5M633 | 01 | AR | AR BCBS | OTHER |