Provider Demographics
NPI:1851322333
Name:HANNA, IRENE ANNELI (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ANNELI
Last Name:HANNA
Suffix:
Gender:F
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:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0695
Mailing Address - Country:US
Mailing Address - Phone:760-776-6543
Mailing Address - Fax:760-776-6546
Practice Address - Street 1:42525 RANCHO MIRAGE LN
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4312
Practice Address - Country:US
Practice Address - Phone:760-776-6543
Practice Address - Fax:760-776-6546
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA440662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A440660Medicare ID - Type Unspecified
CAE50927Medicare UPIN