MEDICARE: DR. KAREN YBERICO FOURIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A165344	CA
2	207Q00000X	Family Medicine Physician	A163544	CA

General Provider Information

NPI Number	:	1467981340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN YBERICO FOURIE MD

Provider Business Mailing Address
First Line	:	3945 WHITTIER BLVD LOS ANGELES, CA 90023
Second Line	:
City	:	BOYLE HEIGHTS
State	:	CA
Zip	:	90023
Country	:	US
Telephone Number	:	541-728-1077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3945 WHITTIER BLVD LOS ANGELES
Second Line	:
City	:	BOYLE HEIGHTS
State	:	CA
Zip	:	90023-4433
Country	:	US
Telephone Number	:	541-728-1077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	07/21/2022

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