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General NPI Number Information
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NPI Number | 1144865965
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Entity Type | Individual
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Provider Name | AY ME IMELDA HAN
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Gender | Female
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 3481 KURTZ ST
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City | SAN DIEGO
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State | CA
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Zip | 92110-4430
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Country | US
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Telephone | 619-320-2404
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 MARINA VILLAGE PKWY STE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-1078
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Country | US
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Telephone | 510-337-7950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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