Provider Demographics
NPI:1174888200
Name:HASAN, LARA (MD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1100 N PALM CANYON DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4414
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:760-327-7905
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 212
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:760-327-7905
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA141184207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174888200Medicaid
CAZZZ27958ZOtherGROUP MEDICARE PTAN
CADQ488AOtherGROUP MEDICARE PTAN