Healthcare Provider Details

I. General information

NPI: 1518527035
Provider Name (Legal Business Name): MARYAN YUSUF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 VILLA LA JOLLA DR
LA JOLLA CA
92037-1949
US

IV. Provider business mailing address

8831 VILLA LA JOLLA DR
LA JOLLA CA
92037-1949
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-4480
  • Fax: 858-457-6992
Mailing address:
  • Phone: 858-457-4480
  • Fax: 858-457-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: