Provider Demographics
NPI:1326828773
Name:SUTHTHEEPRAPHASAWASDEE, HASSANAN
Entity Type:Individual
Prefix:MS
First Name:HASSANAN
Middle Name:
Last Name:SUTHTHEEPRAPHASAWASDEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7652 CLEMENT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828
Mailing Address - Country:US
Mailing Address - Phone:818-966-4464
Mailing Address - Fax:
Practice Address - Street 1:300 HARDING BOULEVARD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:818-966-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERT94359ID166632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist