Provider Demographics
NPI:1659171692
Name:HANNA, DAIQORI
Entity type:Individual
Prefix:
First Name:DAIQORI
Middle Name:
Last Name:HANNA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 MARIA ELENA
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6517
Mailing Address - Country:US
Mailing Address - Phone:505-269-5627
Mailing Address - Fax:
Practice Address - Street 1:5001 INDIAN SCHOOL RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4082
Practice Address - Country:US
Practice Address - Phone:505-548-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker