Provider Demographics
NPI:1639286263
Name:HANEY, FATMA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATMA
Middle Name:
Last Name:HANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FATMA
Other - Middle Name:
Other - Last Name:DENICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:840 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1708
Mailing Address - Country:US
Mailing Address - Phone:575-622-2606
Mailing Address - Fax:575-622-6645
Practice Address - Street 1:840 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1708
Practice Address - Country:US
Practice Address - Phone:575-622-2606
Practice Address - Fax:575-622-6645
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0086208000000X
CAA063529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM60877324Medicaid
CAH43790Medicare UPIN