Healthcare Provider Details

I. General information

NPI: 1932690351
Provider Name (Legal Business Name): MARY HANNON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 304
BEVERLY HILLS CA
90211-2286
US

IV. Provider business mailing address

3 STRATFORD
MANHATTAN BEACH CA
90266-7224
US

V. Phone/Fax

Practice location:
  • Phone: 310-362-3099
  • Fax: 424-355-0555
Mailing address:
  • Phone: 703-774-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY HANNON
Title or Position: OWNER
Credential: MD
Phone: 703-774-4850