Healthcare Provider Details

I. General information

NPI: 1487298667
Provider Name (Legal Business Name): HANNA MARIE MASSEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CHADBOURNE RD STE 201
FAIRFIELD CA
94534-9641
US

IV. Provider business mailing address

2290 SACRAMENTO ST
VALLEJO CA
94590-2929
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-4500
  • Fax: 707-399-9410
Mailing address:
  • Phone: 707-643-5785
  • Fax: 707-643-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: