Provider Demographics
NPI:1134944671
Name:QUACH, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:
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 1519
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-1519
Mailing Address - Country:US
Mailing Address - Phone:208-995-3615
Mailing Address - Fax:
Practice Address - Street 1:4930 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2119
Practice Address - Country:US
Practice Address - Phone:208-995-3615
Practice Address - Fax:833-275-1309
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician