Provider Demographics
NPI:1598342701
Name:HASAN, AFSHAN
Entity Type:Individual
Prefix:
First Name:AFSHAN
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 CALLE BIENVENIDA
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5003
Mailing Address - Country:US
Mailing Address - Phone:909-217-4593
Mailing Address - Fax:
Practice Address - Street 1:1771 3RD ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2670
Practice Address - Country:US
Practice Address - Phone:951-686-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2753466106S00000X
CAY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician