Healthcare Provider Details

I. General information

NPI: 1437441433
Provider Name (Legal Business Name): ROBERT HANSON LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E CENTER ST
ANAHEIM CA
92805-3457
US

IV. Provider business mailing address

9609 MARJORIE ST
PICO RIVERA CA
90660-3301
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0750
  • Fax: 714-780-0757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN220272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: