Provider Demographics
NPI:1972536928
Name:HAHNLOSER, RUDOLF (PHD, PA-C)
Entity type:Individual
Prefix:
First Name:RUDOLF
Middle Name:
Last Name:HAHNLOSER
Suffix:
Gender:M
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 E INDIAN BEND RD APT 2043
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4667
Mailing Address - Country:US
Mailing Address - Phone:480-951-7149
Mailing Address - Fax:
Practice Address - Street 1:4554 E INVERNESS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4639
Practice Address - Country:US
Practice Address - Phone:480-892-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical