Healthcare Provider Details

I. General information

NPI: 1497477251
Provider Name (Legal Business Name): HAKIM MUSA HAMPTON 15369-RAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W. CLINTON AVE BUILDING B, # 128
FRESNO CA
93705
US

IV. Provider business mailing address

2550 W CLINTON AVE RM 128
FRESNO CA
93705-4206
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-9117
  • Fax:
Mailing address:
  • Phone: 559-225-9117
  • Fax: 559-225-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15369-RAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: