Provider Demographics
NPI:1194868224
Name:HANNA, ADEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEL
Middle Name:S
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:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-0008
Mailing Address - Country:US
Mailing Address - Phone:909-374-7216
Mailing Address - Fax:909-627-5184
Practice Address - Street 1:1200 S DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2298
Practice Address - Country:US
Practice Address - Phone:909-374-7216
Practice Address - Fax:909-627-5184
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0641512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641510Medicaid
CAA064151OtherMEDICAL LICENSE
CA00A641510Medicaid