Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A40916 | CA |
NPI | 1194848580 |
---|---|
Provider Name | Nader Michel Yacoub |
First Address | La Puente, CA 91746-2162 |
Second Address | La Puente, CA 91746-2162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 17/09/2016 |