Provider Demographics
NPI:1326651514
Name:AL HASAN, MOHAMMAD MAHMOOD
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MAHMOOD
Last Name:AL HASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 PALMETTO GLEN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6376
Mailing Address - Country:US
Mailing Address - Phone:832-704-6954
Mailing Address - Fax:
Practice Address - Street 1:2109 SAN JACINTO BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1413
Practice Address - Country:US
Practice Address - Phone:512-471-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer