Healthcare Provider Details

I. General information

NPI: 1174062301
Provider Name (Legal Business Name): MOHAMMED ABDUL HANNAN C.R.N.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 COLLEGE OAK DR APT 5
SACRAMENTO CA
95841-4257
US

IV. Provider business mailing address

4701 COLLEGE OAK DR APT 5
SACRAMENTO CA
95841-4257
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-4266
  • Fax:
Mailing address:
  • Phone: 916-572-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000685
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1161565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: