Healthcare Provider Details

I. General information

NPI: 1790179760
Provider Name (Legal Business Name): YAQUB HANSIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8461 TURNPIKE DR STE 102
WESTMINSTER CO
80031-4378
US

IV. Provider business mailing address

1515 MARKET AVE
SAN PABLO CA
94806-4357
US

V. Phone/Fax

Practice location:
  • Phone: 855-626-4244
  • Fax: 720-441-0448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0006448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: