MEDICARE: LIBAN YUSUF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1679363758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIBAN YUSUF

Provider Business Mailing Address
First Line	:	5965 HUGHES ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6519
Country	:	US
Telephone Number	:	858-254-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2358 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:	858-254-0190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ LIBAN YUSUF ” Practice Location

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