Healthcare Provider Details

I. General information

NPI: 1174054639
Provider Name (Legal Business Name): HELEN HANNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 UNIVERSITY AVE
RIVERSIDE CA
92507-4545
US

IV. Provider business mailing address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7669
  • Fax: 951-656-4280
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA165382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: