Healthcare Provider Details

I. General information

NPI: 1457959678
Provider Name (Legal Business Name): HASANI THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27225 CAMP PLENTY RD STE 1D
SANTA CLARITA CA
91351-2654
US

IV. Provider business mailing address

4654 E AVENUE S
PALMDALE CA
93552-4454
US

V. Phone/Fax

Practice location:
  • Phone: 661-542-7055
  • Fax:
Mailing address:
  • Phone: 661-585-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: