Healthcare Provider Details

I. General information

NPI: 1699876011
Provider Name (Legal Business Name): ANNE MARIE HANNEKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 700
LA JOLLA CA
92037-1218
US

IV. Provider business mailing address

9834 GENESEE AVENUE SUITE 315
LA JOLLA CA
92037-1221
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-9666
  • Fax: 858-558-1941
Mailing address:
  • Phone: 858-457-4090
  • Fax: 858-457-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG068946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: