Provider Demographics
NPI:1497722557
Name:HASSANI, MOHAMMAD
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:HASSANI
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 1:280 E DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2746
Mailing Address - Country:US
Mailing Address - Phone:626-740-9530
Mailing Address - Fax:626-442-8840
Practice Address - Street 1:3208 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1360
Practice Address - Country:US
Practice Address - Phone:626-442-7696
Practice Address - Fax:626-442-8840
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 47281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5616985OtherNCPDP