Provider Demographics
NPI:1073835617
Name:HANLEY, JEAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:HANLEY
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 1:1451 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4036
Mailing Address - Country:US
Mailing Address - Phone:310-413-4140
Mailing Address - Fax:323-226-3732
Practice Address - Street 1:1801 E. MARENGO ST., L-902
Practice Address - Street 2:LOS ANGELES COUNTY USC DIVISION OF ALLERGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1083
Practice Address - Country:US
Practice Address - Phone:323-226-3823
Practice Address - Fax:323-226-3732
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072969207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology