MEDICARE: HANAN HANNA AYOUB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	108289	CA

General Provider Information

NPI Number	:	1306562509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANAN HANNA AYOUB

Provider Business Mailing Address
First Line	:	3054 CALAVO DR
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1138
Country	:	US
Telephone Number	:	951-333-4103
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 CALAVO DR
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1138
Country	:	US
Telephone Number	:	951-333-4103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	10/18/2022

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