Provider Demographics
NPI:1235622630
Name:DIMAYUGA, HASAN (DO)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:
Last Name:DIMAYUGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WBAMC/DOM/GME
Mailing Address - Street 2:5005 N PIEDRAS STREET
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:915-742-2180
Mailing Address - Fax:915-742-4363
Practice Address - Street 1:WBAMC/DOM/GME
Practice Address - Street 2:5005 N PIEDRAS STREET
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-742-2180
Practice Address - Fax:915-742-4363
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine