Individual
BASIL M HANTASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
3800 GEER RD STE 200, TURLOCK, CA 95382-1146
(209) 668-3063
(209) 668-4992
Mailing address
3800 GEER RD STE 200, TURLOCK, CA 95382-1146
(209) 668-3063
(209) 668-4992
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A84839
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A848390
MEDI-CAL RENDERING NUMBER
CA
01
—
00A848390
MEDICARE PPIN
—
01
—
ZZZP4312Z
MEDICARE ID
CA
Enumeration date
06/02/2006
Last updated
05/12/2020
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