Healthcare Provider Details

I. General information

NPI: 1285749937
Provider Name (Legal Business Name): YOUSSEF BOULOS HADWEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N 5TH ST
CHOWCHILLA CA
93610-2820
US

IV. Provider business mailing address

129 N 5TH ST
CHOWCHILLA CA
93610-2820
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-0275
  • Fax: 559-665-7126
Mailing address:
  • Phone: 559-665-0275
  • Fax: 559-665-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG74536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: