Provider Demographics
NPI:1639796204
Name:HANNA, MONICA KAMEEL
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KAMEEL
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 1:1736 S VICENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4246
Mailing Address - Country:US
Mailing Address - Phone:714-623-6235
Mailing Address - Fax:
Practice Address - Street 1:12921 FERN ST
Practice Address - Street 2:STE K
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4300
Practice Address - Country:US
Practice Address - Phone:714-623-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor