Healthcare Provider Details

I. General information

NPI: 1770226003
Provider Name (Legal Business Name): MR. MASON WARREN HANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7181 N HUALAPAI WAY STE 975
LAS VEGAS NV
89166-1115
US

IV. Provider business mailing address

9156 ENTICING CT
LAS VEGAS NV
89149-3071
US

V. Phone/Fax

Practice location:
  • Phone: 210-204-4585
  • Fax:
Mailing address:
  • Phone: 702-906-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: