Healthcare Provider Details

I. General information

NPI: 1982936076
Provider Name (Legal Business Name): EHAB HANNA M.D INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA
LAGUNA HILLS CA
92653
US

IV. Provider business mailing address

P.O. BOX 50666
IRVINE CA
92619
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-6430
  • Fax: 949-600-6433
Mailing address:
  • Phone: 949-600-6430
  • Fax: 949-600-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA86056
License Number StateCA

VIII. Authorized Official

Name: EHAB HANNA
Title or Position: OWNER
Credential: M.D.
Phone: 949-600-6430