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General NPI Number Information
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NPI Number | 1992735930
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Entity Type | Individual
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Provider Name | ANDRE S YOUSEFIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 227 W JANSS RD SUITE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1848
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Country | US
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Telephone | 805-230-2333
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Fax | 805-230-2335
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Provider Business Mailing Address
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Address Line | 1336 N MOORPARK RD # 288
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5224
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Country | US
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Telephone | 805-230-2333
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Fax | 805-230-2335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A72667
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License Number State | CA
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