Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A22369 | CA |
Y | 111NI0900X | Internist | A22369 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | A22369 | CA |
N | 207RG0300X | Geriatric Medicine | A22369 | CA |
NPI | 1053421388 |
---|---|
Provider Name | Dr. Hassan Bacchus |
First Address | Lancaster, CA 93539-7007 |
Second Address | Lancaster, CA 93534-4784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 04/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A223690 | (05) | CA |
A23038 | (02) | CA |