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General NPI Number Information
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NPI Number | 1659698181
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Entity Type | Organization
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Legal Business Name | MARK YOUSSEF A MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 1317 5TH ST STE 300
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City | SANTA MONICA
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State | CA
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Zip | 90401-1433
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Country | US
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Telephone | 310-434-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 5TH ST STE 300
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City | SANTA MONICA
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State | CA
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Zip | 90401-1433
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Country | US
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Telephone | 310-434-0044
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Fax |
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Authorized Official
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Title or Position | DIRECT/ SOLE OWNER
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Name | MARK YOUSSEF
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Credential | MD
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Telephone | 818-888-7815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A77473
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License Number State | CA
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