Provider Demographics
NPI:1558311456
Name:FAM, HANAA WADIE (MD)
Entity Type:Individual
Prefix:DR
First Name:HANAA
Middle Name:WADIE
Last Name:FAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4950 BARRANCA PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4671
Mailing Address - Country:US
Mailing Address - Phone:949-857-1871
Mailing Address - Fax:949-857-1879
Practice Address - Street 1:4950 BARRANCA PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4671
Practice Address - Country:US
Practice Address - Phone:949-857-1871
Practice Address - Fax:949-857-1879
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA680932084P0800X, 174400000X
103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral