Healthcare Provider Details

I. General information

NPI: 1053787366
Provider Name (Legal Business Name): GHOZLAND AND YOUSSEF A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 OCEAN AVE STE. 200
SANTA MONICA CA
90401-2108
US

IV. Provider business mailing address

PO BOX 893520
TEMECULA CA
92589-3520
US

V. Phone/Fax

Practice location:
  • Phone: 310-434-0044
  • Fax: 310-434-0099
Mailing address:
  • Phone: 310-434-0044
  • Fax: 310-434-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK YOUSEFF
Title or Position: OWNER
Credential: MD
Phone: 310-434-0044