Healthcare Provider Details

I. General information

NPI: 1740339894
Provider Name (Legal Business Name): ATEF LABIB YACOUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S MONTEBELLO BLVD
MONTEBELLO CA
90640-4730
US

IV. Provider business mailing address

PO BOX 2199
MONTEBELLO CA
90640-8099
US

V. Phone/Fax

Practice location:
  • Phone: 323-720-9204
  • Fax: 323-720-9208
Mailing address:
  • Phone: 323-726-0533
  • Fax: 323-726-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA40189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA40189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: