Healthcare Provider Details

I. General information

NPI: 1669920815
Provider Name (Legal Business Name): JOANNA HAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 DIAMOND BLVD STE 520
CONCORD CA
94520-5719
US

IV. Provider business mailing address

1924 SHASTA LN
HERCULES CA
94547-2756
US

V. Phone/Fax

Practice location:
  • Phone: 925-682-1951
  • Fax:
Mailing address:
  • Phone: 732-421-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9274113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: