Healthcare Provider Details

I. General information

NPI: 1679053763
Provider Name (Legal Business Name): MEDIA YOUNUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 S MAGNOLIA AVE # 101&201
EL CAJON CA
92020-5237
US

IV. Provider business mailing address

436 S MAGNOLIA AVE # 101&201
EL CAJON CA
92020-5237
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: