Healthcare Provider Details

I. General information

NPI: 1447870365
Provider Name (Legal Business Name): MONICA SAMEH HANNA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 BROOKHURST STREET
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

17360 BROOKHURST STREET
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 877-844-0012
  • Fax: 714-665-4680
Mailing address:
  • Phone: 877-844-0012
  • Fax: 714-665-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A21042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: