MEDICARE: HANNA A HOUDE-GLENN

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	174400000X	Specialist	L9540	CA

General Provider Information

NPI Number	:	1497577936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNA A HOUDE-GLENN

Provider Business Mailing Address
First Line	:	3350 HAWTHORN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-5619
Country	:	US
Telephone Number	:	619-892-0886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 HAWTHORN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-5619
Country	:	US
Telephone Number	:	619-892-0886
Fax Number	:

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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Directions to “ HANNA A HOUDE-GLENN ” Practice Location

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