Provider Demographics
NPI:1548927387
Name:HASAN, NAZLI
Entity type:Individual
Prefix:
First Name:NAZLI
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 1:2069 W SAN BERNARDINO AVE
Mailing Address - Street 2:APT #2057
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:951-265-1735
Mailing Address - Fax:
Practice Address - Street 1:2069 W SAN BERNARDINO AVE
Practice Address - Street 2:APT #2057
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9232
Practice Address - Country:US
Practice Address - Phone:951-265-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty