Provider Demographics
NPI:1497577936
Name:HOUDE-GLENN, HANNA A
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:A
Last Name:HOUDE-GLENN
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 1:3350 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5619
Mailing Address - Country:US
Mailing Address - Phone:619-892-0886
Mailing Address - Fax:
Practice Address - Street 1:3350 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-5619
Practice Address - Country:US
Practice Address - Phone:619-892-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist