Healthcare Provider Details

I. General information

NPI: 1194851394
Provider Name (Legal Business Name): SONIA YOUSUF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W SLAUGHTER LN SUITE 490
AUSTIN TX
78748-6230
US

IV. Provider business mailing address

4515 SETON CENTER PKWY SUITE 215-CREDENTIALING
AUSTIN TX
78759-5290
US

V. Phone/Fax

Practice location:
  • Phone: 512-282-8937
  • Fax: 512-406-7351
Mailing address:
  • Phone:
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301089195
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberQ0850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: