MEDICARE: DR. SHAZIA MAHMOOD HASAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A55223	CA

General Provider Information

NPI Number	:	1073565107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAZIA MAHMOOD HASAN M.D.

Provider Business Mailing Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	SUITE 400
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-675-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	SUITE 400
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-675-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/13/2021

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