MEDICARE: MRS. YASMIN M HASSAN

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	172A00000X	Driver	D4180288	CA

General Provider Information

NPI Number	:	1790005031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YASMIN M HASSAN

Provider Business Mailing Address
First Line	:	6939 TERRA COTTA RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-7919
Country	:	US
Telephone Number	:	619-434-7582
Fax Number	:	619-434-7582

Provider Business Practice Location Address
First Line	:	6939 TERRA COTTA RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-7919
Country	:	US
Telephone Number	:	619-434-7582
Fax Number	:	619-434-7582

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	06/09/2010

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