Healthcare Provider Details

I. General information

NPI: 1477244341
Provider Name (Legal Business Name): YUSEF NOFAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2496 1/2 N MACY ST
SAN BERNARDINO CA
92407-6597
US

IV. Provider business mailing address

1089 W HUFF ST
RIALTO CA
92376-6826
US

V. Phone/Fax

Practice location:
  • Phone: 646-523-8208
  • Fax:
Mailing address:
  • Phone: 646-523-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number361881241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: