=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861378580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AREEA YASSAN R.T. (R)
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2542 ALDER LN
-----------------------------------------------------
City | MCKINLEYVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95519-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-680-3559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2542 ALDER LN
-----------------------------------------------------
City | MCKINLEYVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95519-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-680-3559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471C3402X
-----------------------------------------------------
Taxonomy Name | Radiography Radiologic Technologist
-----------------------------------------------------
License Number | RHF00118484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------