Healthcare Provider Details

I. General information

NPI: 1215499256
Provider Name (Legal Business Name): ASBAT HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMAD ASBAT HASAN MD

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 BROCKTON AVE STE 204
RIVERSIDE CA
92506-2233
US

IV. Provider business mailing address

3956 LAVINE WAY UNIT 110
CORONA CA
92883-3651
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-7700
  • Fax: 851-781-0313
Mailing address:
  • Phone: 951-315-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number178990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: