Basic Information
| Provider Information | |||||||||
| NPI: | 1790165785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASANUDDIN | ||||||||
| FirstName: | HARRISON | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 HIGHLANDS DR | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175437694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176255000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2315 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167342011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QB0002X | OT016681 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine | 207Q00000X | OT016681 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS1201X | OT016681 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | 207Q00000X | OT016681 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.