Healthcare Provider Details

I. General information

NPI: 1659932606
Provider Name (Legal Business Name): EEMAN HASAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 OLDS RD
OXNARD CA
93033-8061
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-986-5551
  • Fax: 805-986-5556
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: