MEDICARE: HARUN ABDI HASHI

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	172A00000X	Driver	172A00000X	CA

General Provider Information

NPI Number	:	1558148304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARUN ABDI HASHI

Provider Business Mailing Address
First Line	:	4032 WINONA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-2115
Country	:	US
Telephone Number	:	619-946-0491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4032 WINONA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-2115
Country	:	US
Telephone Number	:	619-946-0491
Fax Number	:

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

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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