Healthcare Provider Details

I. General information

NPI: 1831891456
Provider Name (Legal Business Name): MENA HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W COVINA BLVD
SAN DIMAS CA
91773-3245
US

IV. Provider business mailing address

3753 GRACE AVE
BALDWIN PARK CA
91706-4035
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-6811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA207397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: