Healthcare Provider Details

I. General information

NPI: 1053948380
Provider Name (Legal Business Name): LEANNA HANSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S STE 400
ORANGE CA
92868-3201
US

IV. Provider business mailing address

15525 POMERADO RD STE A2
POWAY CA
92064-2425
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5691
  • Fax: 714-456-8874
Mailing address:
  • Phone: 858-451-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA194094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: