Healthcare Provider Details

I. General information

NPI: 1891367694
Provider Name (Legal Business Name): FIRST CHOICE HEALTH AND SPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 302
GLENDALE CA
91204-4388
US

IV. Provider business mailing address

800 S CENTRAL AVE STE 302
GLENDALE CA
91204-4388
US

V. Phone/Fax

Practice location:
  • Phone: 818-696-9099
  • Fax: 818-696-9098
Mailing address:
  • Phone: 818-696-9099
  • Fax: 818-696-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAM S HASAN
Title or Position: CEO
Credential: MD
Phone: 818-696-9099