MEDICARE: ANDREW HANNA D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	18051	CA
2	208VP0000X	Pain Medicine Physician	18051	CA
3	208VP0014X	Interventional Pain Medicine Physician	18051	CA
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	18051	CA

General Provider Information

NPI Number	:	1972042620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW HANNA D.O.

Provider Business Mailing Address
First Line	:	3662 KATELLA AVE STE 117
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3174
Country	:	US
Telephone Number	:	310-507-7984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 KATELLA AVE STE 117
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3174
Country	:	US
Telephone Number	:	310-507-7984
Fax Number	:

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

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	04/27/2026

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