Healthcare Provider Details

I. General information

NPI: 1043788615
Provider Name (Legal Business Name): HISHAM MAASSARANI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

7552 AMAZON DR APT 1
HUNTINGTON BEACH CA
92647-8655
US

V. Phone/Fax

Practice location:
  • Phone: 909-302-4886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: