MEDICARE: OMAR M ALHASSOON PH.D.

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	103G00000X	Clinical Neuropsychologist	22494	CA
2	103T00000X	Psychologist	22494	CA
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist	22494	CA
4	103TA0700X	Adult Development & Aging Psychologist	22494	CA
5	103TB0200X	Cognitive & Behavioral Psychologist	22494	CA
6	103TC0700X	Clinical Psychologist	22494	CA
7	103TH0004X	Health Psychologist	22494	CA
8	103TP2701X	Group Psychotherapy Psychologist	22494	CA
9	103TR0400X	Rehabilitation Psychologist	22494	CA

General Provider Information

NPI Number	:	1275085789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR M ALHASSOON PH.D.

Provider Business Mailing Address
First Line	:	591 CAMINO DE LA REINA
Second Line	:	SUITE 1217
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3102
Country	:	US
Telephone Number	:	619-800-8743
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 CAMINO DE LA REINA
Second Line	:	SUITE 1217
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3102
Country	:	US
Telephone Number	:	619-800-8743
Fax Number	:

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

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	11/01/2016

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