Healthcare Provider Details

I. General information

NPI: 1891337812
Provider Name (Legal Business Name): ALI-AKBAR HASSAN SHAHINE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: N/A N/A N/A

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY
VISTA CA
92083-6031
US

IV. Provider business mailing address

45905 CORTE ORIZABA
TEMECULA CA
92592-1250
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-2550
  • Fax:
Mailing address:
  • Phone: 734-749-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95012821
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95012821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: