Healthcare Provider Details

I. General information

NPI: 1992455471
Provider Name (Legal Business Name): ANDREW HANALLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 W PACKWOOD AVE
VISALIA CA
93277-5033
US

IV. Provider business mailing address

PO BOX 4379
VISALIA CA
93278-4379
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2000
  • Fax:
Mailing address:
  • Phone: 559-734-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A21668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: