Healthcare Provider Details

I. General information

NPI: 1104855600
Provider Name (Legal Business Name): ANTOINE THOMAS HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE 230
OXNARD CA
93030-3790
US

IV. Provider business mailing address

1700 N ROSE AVE
OXNARD CA
93030-7641
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-2811
  • Fax: 805-981-4445
Mailing address:
  • Phone: 805-988-2811
  • Fax: 805-981-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA43969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: