Provider Demographics
NPI:1699876011
Name:HANNEKEN, ANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARIE
Last Name:HANNEKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9834 GENESEE AVENUE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1221
Mailing Address - Country:US
Mailing Address - Phone:858-457-4090
Mailing Address - Fax:858-457-1543
Practice Address - Street 1:9850 GENESEE AVE STE 700
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1218
Practice Address - Country:US
Practice Address - Phone:858-558-9666
Practice Address - Fax:858-558-1941
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG068946207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G689460Medicaid
180041603OtherRAILROAD MEDICARE
CA00G689460Medicaid
C84308Medicare UPIN