Provider Demographics
NPI:1538581913
Name:EHAB YACOUB MD INC.
Entity type:Organization
Organization Name:EHAB YACOUB MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:S
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-592-4529
Mailing Address - Street 1:14541 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2820
Mailing Address - Country:US
Mailing Address - Phone:310-515-8113
Mailing Address - Fax:310-538-2102
Practice Address - Street 1:14541 DELANO ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2820
Practice Address - Country:US
Practice Address - Phone:877-515-8113
Practice Address - Fax:877-538-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA762442084P0804X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty