Provider Demographics
NPI:1942395496
Name:HASSAN, LAILA (MD PA)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 ASTORIA BLVD. #330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089
Mailing Address - Country:US
Mailing Address - Phone:281-922-4000
Mailing Address - Fax:281-922-4242
Practice Address - Street 1:11914 ASTORIA BLVD. #330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089
Practice Address - Country:US
Practice Address - Phone:281-922-4000
Practice Address - Fax:281-922-4242
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3009305R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123653101Medicaid
TX123653101Medicaid
TX00N57LMedicare PIN