Healthcare Provider Details

I. General information

NPI: 1972500403
Provider Name (Legal Business Name): EHAB GAMIL HANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

11401 SOUTH BLOOMFIELD AVE.
NORWALK CA
90650
US

IV. Provider business mailing address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax: 562-864-4560
Mailing address:
  • Phone: 562-863-7011
  • Fax: 562-864-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: