Provider Demographics
NPI:1316279813
Name:FATIMA H. HAKKAK D.O., INC.
Entity type:Organization
Organization Name:FATIMA H. HAKKAK D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAKKAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-990-1157
Mailing Address - Street 1:8780 19TH ST # 353
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4608
Mailing Address - Country:US
Mailing Address - Phone:909-990-1157
Mailing Address - Fax:909-579-6476
Practice Address - Street 1:1183 E FOOTHILL BLVD STE 260
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4084
Practice Address - Country:US
Practice Address - Phone:909-990-1157
Practice Address - Fax:909-579-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A10650Medicare PIN