Provider Demographics
NPI:1912302050
Name:KAMIL HASSEN, EYOB
Entity type:Individual
Prefix:
First Name:EYOB
Middle Name:
Last Name:KAMIL HASSEN
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 1:7257 KARI ANN CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-2146
Mailing Address - Country:US
Mailing Address - Phone:926-968-0263
Mailing Address - Fax:
Practice Address - Street 1:7257 KARI ANN CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-2146
Practice Address - Country:US
Practice Address - Phone:926-968-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN278225164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse