Healthcare Provider Details

I. General information

NPI: 1649106444
Provider Name (Legal Business Name): RUA ISSA HASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N CENTRAL AVE
GLENDALE CA
91203-1249
US

IV. Provider business mailing address

617 ASH MEADOW LN
WALNUT CA
91789-4140
US

V. Phone/Fax

Practice location:
  • Phone: 818-649-2921
  • Fax:
Mailing address:
  • Phone: 714-461-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: