MEDICARE: DR. JEAN MARIE HANLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	G072969	CA

General Provider Information

NPI Number	:	1073835617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN MARIE HANLEY M.D.

Provider Business Mailing Address
First Line	:	425 15TH ST UNIT 3071
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-7305
Country	:	US
Telephone Number	:	310-413-4140
Fax Number	:	888-981-7934

Provider Business Practice Location Address
First Line	:	1131 N PACIFIC AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2358
Country	:	US
Telephone Number	:	818-639-8780
Fax Number	:	888-981-7934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	01/20/2026

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