Healthcare Provider Details

I. General information

NPI: 1093676785
Provider Name (Legal Business Name): SAL WAIL HANNA CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 1ST ST
TUSTIN CA
92780-3004
US

IV. Provider business mailing address

7451 WARNER AVE # E-191
HUNTINGTON BEACH CA
92647-5494
US

V. Phone/Fax

Practice location:
  • Phone: 949-467-1000
  • Fax:
Mailing address:
  • Phone: 949-467-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: