Provider Demographics
NPI:1235895996
Name:HANNA, LINDA HABIB
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:HABIB
Last Name:HANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LA CUENTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3008
Mailing Address - Country:US
Mailing Address - Phone:619-765-9615
Mailing Address - Fax:
Practice Address - Street 1:9975 RUE CHANTEMAR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3205
Practice Address - Country:US
Practice Address - Phone:858-271-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4078494OtherCALIFORNIA IDENTIFICATION CARD