Individual
NAHIDH W HASANIYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.PHD
Contact information
Practice address
401 E HIGHLAND AVE STE 251, SAN BERNARDINO, CA 92404-3800
(909) 882-4605
(909) 475-2680
Mailing address
3400 DATA DR, ATTN: CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A51994
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A519940
—
CA
Enumeration date
06/25/2006
Last updated
01/07/2019
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