Healthcare Provider Details

I. General information

NPI: 1609898253
Provider Name (Legal Business Name): ROBERT JAMES HANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23500 MADISON ST
TORRANCE CA
90505-4702
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-2710
  • Fax: 310-784-2716
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG53478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: