Provider Demographics
NPI:1396193868
Name:HUSSAIN, BASHARAT (PA)
Entity Type:Individual
Prefix:
First Name:BASHARAT
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41880 KALMIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8835
Mailing Address - Country:US
Mailing Address - Phone:951-397-4226
Mailing Address - Fax:951-461-6973
Practice Address - Street 1:41880 KALMIA ST STE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8835
Practice Address - Country:US
Practice Address - Phone:951-397-4226
Practice Address - Fax:951-461-6973
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6389363A00000X
NVPA53567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant