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General NPI Number Information
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NPI Number | 1720125339
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Entity Type | Individual
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Provider Name | HASSAN ASSL MSPA
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1191 E YOSEMITE AVE STE C
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City | MANTECA
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State | CA
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Zip | 95336-5011
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Country | US
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Telephone | 209-239-8689
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Fax | 209-824-3958
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Provider Business Mailing Address
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Address Line | 801 ATHERTON DR APT 10
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City | MANTECA
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State | CA
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Zip | 95337-8596
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Country | US
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Telephone | 714-336-2337
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 18602
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License Number State | CA
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