1699876011 NPI number — DR. ANNE MARIE HANNEKEN MD

Table of content: DR. ANNE MARIE HANNEKEN MD (NPI 1699876011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699876011 NPI number — DR. ANNE MARIE HANNEKEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNEKEN
Provider First Name:
ANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699876011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9834 GENESEE AVENUE
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-457-4090
Provider Business Mailing Address Fax Number:
858-457-1543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9850 GENESEE AVE STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-558-9666
Provider Business Practice Location Address Fax Number:
858-558-1941
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G068946 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G689460 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180041603 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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