MEDICARE: FOZIA KAMIL HASSEN LVN

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	164X00000X	Licensed Vocational Nurse	VN 273359	CA

General Provider Information

NPI Number	:	1437555240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FOZIA KAMIL HASSEN LVN

Provider Business Mailing Address
First Line	:	9383 WILLOW POND CIR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1266
Country	:	US
Telephone Number	:	916-425-4622
Fax Number	:	916-381-9026

Provider Business Practice Location Address
First Line	:	9383 WILLOW POND CIR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1266
Country	:	US
Telephone Number	:	916-425-4622
Fax Number	:	916-381-9026

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

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	11/06/2014

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