=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235524612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WALEED HUSSEIN M.B.B.S.,
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2015
-----------------------------------------------------
Last Update Date | 06/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 SUNSET DR
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95023-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-344-9781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20050 RODRIGUES AVE APT G
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-3148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-344-9781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | A156472
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------