Provider Demographics
NPI:1831247766
Name:HANNA, IMAN NABIL (MD)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:NABIL
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 1:585N MOUNTAIN AVE B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8516
Mailing Address - Country:US
Mailing Address - Phone:909-931-3388
Mailing Address - Fax:909-931-7311
Practice Address - Street 1:585N MOUNTAIN AVE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8516
Practice Address - Country:US
Practice Address - Phone:909-931-3388
Practice Address - Fax:909-931-7311
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA552592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry