Healthcare Provider Details

I. General information

NPI: 1477174340
Provider Name (Legal Business Name): GHASSAN HUSSEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 05/02/2020
Certification Date: 05/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 PARKS AVE APT 1
LA MESA CA
91942-8694
US

IV. Provider business mailing address

9455 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1297
US

V. Phone/Fax

Practice location:
  • Phone: 909-697-0632
  • Fax:
Mailing address:
  • Phone: 858-266-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number34123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: