Provider Demographics
NPI:1538667860
Name:HASSAN, MICAELA (CPHW)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:CPHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S BRISTOL ST # 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6207
Mailing Address - Country:US
Mailing Address - Phone:714-426-5125
Mailing Address - Fax:714-426-5205
Practice Address - Street 1:2720 S BRISTOL ST # 200
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6207
Practice Address - Country:US
Practice Address - Phone:714-426-5125
Practice Address - Fax:714-426-5205
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator