Healthcare Provider Details

I. General information

NPI: 1982634697
Provider Name (Legal Business Name): HODA E. HANNALLAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

IV. Provider business mailing address

PO BOX 3160
APACHE JUNCTION AZ
85117-4115
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0065
  • Fax: 480-288-5339
Mailing address:
  • Phone: 480-983-0065
  • Fax: 480-288-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25477
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: