Provider Demographics
NPI:1790005031
Name:HASSAN, YASMIN M
Entity Type:Individual
Prefix:MRS
First Name:YASMIN
Middle Name:M
Last Name:HASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:FARXAN
Other - Middle Name:M
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6939 TERRA COTTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7919
Mailing Address - Country:US
Mailing Address - Phone:619-434-7582
Mailing Address - Fax:619-434-7582
Practice Address - Street 1:6939 TERRA COTTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7919
Practice Address - Country:US
Practice Address - Phone:619-434-7582
Practice Address - Fax:619-434-7582
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4180288172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver