Healthcare Provider Details

I. General information

NPI: 1508847625
Provider Name (Legal Business Name): LABIB HASHIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE SUITE 105
CHINO CA
91710-1401
US

IV. Provider business mailing address

13768 ROSWELL AVE SUITE 105
CHINO CA
91710-1401
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-0814
  • Fax: 909-364-9929
Mailing address:
  • Phone: 909-591-0814
  • Fax: 909-364-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA47961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: