Healthcare Provider Details

I. General information

NPI: 1083876643
Provider Name (Legal Business Name): LENORE REEVA CS YOUSSEFI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENORE REEVA C SIMANGAN M.D.

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E. BIDWELL STREET SUITE 250
FOLSOM CA
95630
US

IV. Provider business mailing address

10470 OLD PLACERVILLE ROAD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-817-3700
  • Fax: 916-817-3721
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17235
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA121519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: