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General NPI Number Information
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NPI Number | 1720482029
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Entity Type | Organization
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Legal Business Name | JEFFREY D YUSIM MD
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 950 E VISTA WAY SUITE C
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City | VISTA
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State | CA
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Zip | 92084-5200
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Country | US
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Telephone | 760-295-7677
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Fax | 760-295-7690
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Provider Business Mailing Address
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Address Line | 950 E VISTA WAY SUITE C
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City | VISTA
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State | CA
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Zip | 92084-5252
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Country | US
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Telephone | 760-295-7677
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Fax | 760-295-7690
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DAVID YUSIM
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Credential | M.D.
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Telephone | 760-295-7677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A45129
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License Number State | CA
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