Provider Demographics
NPI:1104135300
Name:HAZZAN, HALA E (RPT)
Entity type:Individual
Prefix:MS
First Name:HALA
Middle Name:E
Last Name:HAZZAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 CAMINITO DE LA MONTANA
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-3044
Mailing Address - Country:US
Mailing Address - Phone:818-266-8500
Mailing Address - Fax:
Practice Address - Street 1:1869 CAMINITO DE LA MONTANA
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-3044
Practice Address - Country:US
Practice Address - Phone:818-266-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist