Healthcare Provider Details

I. General information

NPI: 1790720175
Provider Name (Legal Business Name): HANNS C HAESSLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 TRIBUTE RD SUITE 200
SACRAMENTO CA
95815-4305
US

IV. Provider business mailing address

459 WYNDGATE RD
SACRAMENTO CA
95864-5936
US

V. Phone/Fax

Practice location:
  • Phone: 916-678-5400
  • Fax: 916-678-7666
Mailing address:
  • Phone: 916-485-3816
  • Fax: 916-483-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG21049
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG21049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: