Healthcare Provider Details

I. General information

NPI: 1154599330
Provider Name (Legal Business Name): YOUSSEF ADEL REZK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 11/22/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N LOOP RD WHC
FORT IRWIN CA
92310-5109
US

IV. Provider business mailing address

390 N LOOP RD WHC
FORT IRWIN CA
92310-5109
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5355
  • Fax:
Mailing address:
  • Phone: 760-383-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301073856
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number247536
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number247536
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01075866A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD-50330
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberFE60428130
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01075866A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60808
License Number StateTN
# 9
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-50330
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: