Provider Demographics
NPI:1326801259
Name:BACK TO PREVENTION, LLC
Entity Type:Organization
Organization Name:BACK TO PREVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MS
Authorized Official - Phone:619-517-8748
Mailing Address - Street 1:3604 ALEXIA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2235
Mailing Address - Country:US
Mailing Address - Phone:619-517-8748
Mailing Address - Fax:
Practice Address - Street 1:3706 RUFFIN RD # 129
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1812
Practice Address - Country:US
Practice Address - Phone:858-587-1822
Practice Address - Fax:858-587-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty