MEDICARE: KHADIJA H HAMISI NP

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	163W00000X	Registered Nurse	698511	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20560	CA

General Provider Information

NPI Number	:	1225360498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHADIJA H HAMISI NP

Provider Business Mailing Address
First Line	:	1747 STEINMAN ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-7809
Country	:	US
Telephone Number	:	951-906-4786
Fax Number	:

Provider Business Practice Location Address
First Line	:	11801 PIERCE ST STE 200
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-4400
Country	:	US
Telephone Number	:	909-429-3244
Fax Number	:	909-981-0821

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	05/22/2023

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