Provider Demographics
NPI:1942348255
Name:HANNA, LAILA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:
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 1:1911 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-4744
Mailing Address - Country:US
Mailing Address - Phone:818-843-6640
Mailing Address - Fax:818-843-0347
Practice Address - Street 1:1911 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-4744
Practice Address - Country:US
Practice Address - Phone:818-843-6640
Practice Address - Fax:818-843-0347
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954805523OtherTAX ID NUMBER