Provider Demographics
NPI:1174659064
Name:GHASSAN HADI MD INC
Entity Type:Organization
Organization Name:GHASSAN HADI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-981-8904
Mailing Address - Street 1:2352 DEL MARINO
Mailing Address - Street 2:PO.O.BOX 279
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1106
Mailing Address - Country:US
Mailing Address - Phone:909-981-8904
Mailing Address - Fax:909-981-8943
Practice Address - Street 1:1060 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4027
Practice Address - Country:US
Practice Address - Phone:909-981-8904
Practice Address - Fax:909-981-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43603Medicare UPIN