Provider Demographics
NPI:1871664540
Name:HANSEN, VERNAL MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:VERNAL
Middle Name:MARTIN
Last Name:HANSEN
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 1:2557 CHINO HILLS PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709
Mailing Address - Country:US
Mailing Address - Phone:909-393-4334
Mailing Address - Fax:909-393-4330
Practice Address - Street 1:2557 CHINO HILLS PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709
Practice Address - Country:US
Practice Address - Phone:909-393-4334
Practice Address - Fax:909-393-4330
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34639208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74073Medicare UPIN