Provider Demographics
NPI:1487047379
Name:EL JAROUCHE, MAYSOUN YOSSEF (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MAYSOUN
Middle Name:YOSSEF
Last Name:EL JAROUCHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3750
Mailing Address - Country:US
Mailing Address - Phone:419-250-9273
Mailing Address - Fax:
Practice Address - Street 1:960 W WOOSTER ST STE 107
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2646
Practice Address - Country:US
Practice Address - Phone:419-373-7692
Practice Address - Fax:419-373-4198
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004313363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical