Provider Demographics
NPI:1417136128
Name:HASSAN, ALSHAFIE MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:ALSHAFIE
Middle Name:MOHAMED
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EAST PALOMAR STREET
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:619-397-3380
Practice Address - Street 1:1400 EAST PALOMAR STREET
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:619-397-3380
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99070207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine