MEDICARE: SOSSANA HANNA

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	122300000X	Dentist	110172	CA

General Provider Information

NPI Number	:	1619711793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOSSANA HANNA

Provider Business Mailing Address
First Line	:	7903 ELM AVE APT 36
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-6868
Country	:	US
Telephone Number	:	386-310-9167
Fax Number	:

Provider Business Practice Location Address
First Line	:	7903 ELM AVE APT 36
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-6868
Country	:	US
Telephone Number	:	386-310-9167
Fax Number	:

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

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	07/02/2024

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Directions to “ SOSSANA HANNA ” Practice Location

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