Healthcare Provider Details

I. General information

NPI: 1578870366
Provider Name (Legal Business Name): BASSEM NABIL HABIB HENEIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 E FLORENCE AVE
LOS ANGELES CA
90001-2536
US

IV. Provider business mailing address

10357 MATTOCK AVE
DOWNEY CA
90241-3004
US

V. Phone/Fax

Practice location:
  • Phone: 323-587-6336
  • Fax:
Mailing address:
  • Phone: 562-480-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: