Provider Demographics
NPI:1790547727
Name:HASSAN, ABDIRAHMAN MOHAMED
Entity Type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:MOHAMED
Last Name:HASSAN
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 1:1501 SOUTHCROSS DR W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6938
Mailing Address - Country:US
Mailing Address - Phone:952-456-1474
Mailing Address - Fax:952-351-9258
Practice Address - Street 1:1501 SOUTHCROSS DR W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6938
Practice Address - Country:US
Practice Address - Phone:952-456-1474
Practice Address - Fax:952-351-9258
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician