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General NPI Number Information
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NPI Number | 1841486263
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Entity Type | Individual
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Provider Name | HANI S GHAWI MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 350 E VANDERBILT WAY STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3593
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Country | US
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Telephone | 909-886-5200
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Fax | 909-382-9017
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Provider Business Mailing Address
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Address Line | 350 E VANDERBILT WAY STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3593
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Country | US
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Telephone | 909-886-5200
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Fax | 909-382-9017
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 036-125433
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | C164666
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License Number State | CA
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