Healthcare Provider Details

I. General information

NPI: 1801854450
Provider Name (Legal Business Name): TAREK I. HASSANEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORANGE AVE STE 101
CORONADO CA
92118-1408
US

IV. Provider business mailing address

PO BOX 181770
CORONADO CA
92178-1770
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-0399
  • Fax:
Mailing address:
  • Phone: 619-964-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA54452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA54452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: