1902285570 NPI number — MS. RACHEL HANNON N.P.

Table of content: MS. RACHEL HANNON N.P. (NPI 1902285570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902285570 NPI number — MS. RACHEL HANNON N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNON
Provider First Name:
RACHEL
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1902285570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91346-9602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-837-5559
Provider Business Mailing Address Fax Number:
818-792-4793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26357 MCBEAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-4488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-869-7248
Provider Business Practice Location Address Fax Number:
818-869-2709
Provider Enumeration Date:
05/28/2015

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: 363LF0000X , with the licence number:  95001931 , 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)





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