Provider Demographics
NPI:1790287696
Name:HANOUM, VERONICA COLLEEN (SUDRC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:COLLEEN
Last Name:HANOUM
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3083
Mailing Address - Country:US
Mailing Address - Phone:530-933-1869
Mailing Address - Fax:
Practice Address - Street 1:50 W MAIN ST STE 110M
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3083
Practice Address - Country:US
Practice Address - Phone:530-933-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker