Provider Demographics
NPI:1104855600
Name:HANNA, ANTOINE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:THOMAS
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7641
Mailing Address - Country:US
Mailing Address - Phone:805-988-2811
Mailing Address - Fax:805-981-4445
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:230
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-988-2811
Practice Address - Fax:805-981-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43969207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A439690Medicaid
CAE28294Medicare UPIN
CA00A439690Medicaid