Healthcare Provider Details

I. General information

NPI: 1437884467
Provider Name (Legal Business Name): YOUSSEF ADLI KUDSI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WALNUT AVE STE 208
SANTA CRUZ CA
95060-3929
US

IV. Provider business mailing address

314 MAIN ST
SANTA CRUZ CA
95060-5018
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: