Healthcare Provider Details

I. General information

NPI: 1982154829
Provider Name (Legal Business Name): ORACLE HEALTH & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W PIONEER DR STE 112B
IRVING TX
75061-7124
US

IV. Provider business mailing address

1425 W PIONEER DR STE 112B
IRVING TX
75061-7124
US

V. Phone/Fax

Practice location:
  • Phone: 682-433-2770
  • Fax:
Mailing address:
  • Phone: 682-433-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberL4429
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberL4429
License Number StateTX

VIII. Authorized Official

Name: DR. MOHAMMED HASSAN YOUSSEF
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 469-230-6226