Healthcare Provider Details

I. General information

NPI: 1780144857
Provider Name (Legal Business Name): MARY FAROUK YOUSSEF MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ STE 37-384
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

760 WESTWOOD PLZ STE 37-384
LOS ANGELES CA
90024-5055
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-1289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA180929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: