Healthcare Provider Details

I. General information

NPI: 1811801996
Provider Name (Legal Business Name): HASSAN MALIK HERCULES-BARNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BROOKHOLLOW DR STE 106
SANTA ANA CA
92705-5428
US

IV. Provider business mailing address

588 W BAY ST
COSTA MESA CA
92627-2607
US

V. Phone/Fax

Practice location:
  • Phone: 657-298-2321
  • Fax:
Mailing address:
  • Phone: 310-213-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC20102
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: