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General NPI Number Information
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NPI Number | 1225360498
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Entity Type | Individual
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Provider Name | KHADIJA H HAMISI NP
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Gender | Female
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 11801 PIERCE ST STE 200
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City | RIVERSIDE
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State | CA
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Zip | 92505-4400
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Country | US
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Telephone | 909-429-3244
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Fax | 909-981-0821
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Provider Business Mailing Address
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Address Line | 1747 STEINMAN ST
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City | RIVERSIDE
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State | CA
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Zip | 92507-7809
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Country | US
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Telephone | 951-906-4786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 698511
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 20560
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License Number State | CA
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