Provider Demographics
NPI:1700119930
Name:QASIM, ABUL (PSYCH TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ABUL
Middle Name:
Last Name:QASIM
Suffix:
Gender:M
Credentials:PSYCH TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PEPPER DR
Mailing Address - Street 2:APT # B
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3329
Mailing Address - Country:US
Mailing Address - Phone:559-584-1827
Mailing Address - Fax:
Practice Address - Street 1:441 PEPPER DR
Practice Address - Street 2:APT # B
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3329
Practice Address - Country:US
Practice Address - Phone:559-584-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34961167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician