Provider Demographics
NPI:1346262615
Name:FATEMI, HASHEM M
Entity Type:Individual
Prefix:
First Name:HASHEM
Middle Name:M
Last Name:FATEMI
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 1:1811 CALAVERA PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1823
Mailing Address - Country:US
Mailing Address - Phone:714-523-7122
Mailing Address - Fax:714-523-9813
Practice Address - Street 1:5471 LA PALMA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1745
Practice Address - Country:US
Practice Address - Phone:714-523-7122
Practice Address - Fax:714-523-9813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22624207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23179Medicare UPIN
CAWA22624DMedicare PIN