Provider Demographics
NPI:1972500403
Name:HANNA, EHAB GAMIL (MD)
Entity Type:Individual
Prefix:MR
First Name:EHAB
Middle Name:GAMIL
Last Name:HANNA
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 1:11401 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2015
Mailing Address - Country:US
Mailing Address - Phone:562-863-7011
Mailing Address - Fax:562-864-4560
Practice Address - Street 1:11401 SOUTH BLOOMFIELD AVE.
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-863-7011
Practice Address - Fax:562-864-4560
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-08-03
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CAA860562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86056OtherLICENSE
CAA86056OtherLICENSE
CAA86056Medicare ID - Type Unspecified