Provider Demographics
NPI:1104573005
Name:ALKACHOURI, HASSAN M
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:M
Last Name:ALKACHOURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 BROOKS ST STE A
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4728
Mailing Address - Country:US
Mailing Address - Phone:951-552-5004
Mailing Address - Fax:
Practice Address - Street 1:267 ALDAMA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1749
Practice Address - Country:US
Practice Address - Phone:909-576-8144
Practice Address - Fax:909-766-2995
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3721422343900000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770136426OtherNPI
CA12074343OtherGROUND MEDICAL TRANSPORTATION
CA1770136426OtherNPI
CA1104573005OtherBILING MEDICAL FOR NEMT SERVICES
CA1770136426Medicaid