Healthcare Provider Details

I. General information

NPI: 1801237482
Provider Name (Legal Business Name): ROBERT CHARLES HANLEY SR. HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6427 E PACIFIC COAST HWY A4
LONG BEACH CA
90803-4201
US

IV. Provider business mailing address

6427 E PACIFIC COAST HWY A4
LONG BEACH CA
90803-4201
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-1400
  • Fax:
Mailing address:
  • Phone: 562-430-1400
  • Fax: 562-430-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: