Provider Demographics
NPI:1639185903
Name:HANNA, TODD CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:CHRISTOPHER
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 1:22438 BEAR CREEK DR N
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5004
Mailing Address - Country:US
Mailing Address - Phone:760-445-8988
Mailing Address - Fax:
Practice Address - Street 1:28400 MCCALL BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92585-9658
Practice Address - Country:US
Practice Address - Phone:951-672-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73905207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU852YMedicare PIN
CABU852ZMedicare PIN
CAF32928Medicare UPIN