Healthcare Provider Details

I. General information

NPI: 1104010420
Provider Name (Legal Business Name): DAVID G HANS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 MONTGOMERY BLVD NE SUITE 200
ALBUQUERQUE NM
87109-6747
US

IV. Provider business mailing address

6400 WYOMING BLVD NE
ALBUQUERQUE NM
87109-3843
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-9477
  • Fax:
Mailing address:
  • Phone: 505-401-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNM831
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: