Healthcare Provider Details

I. General information

NPI: 1467097527
Provider Name (Legal Business Name): DENEANE HANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 GEORGIA ST. STE 102
VALLEJO CA
94590
US

IV. Provider business mailing address

5624 BARRETT AVE
EL CERRITO CA
94530-1407
US

V. Phone/Fax

Practice location:
  • Phone: 888-544-5553
  • Fax:
Mailing address:
  • Phone: 415-286-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: