Individual
GRACE CAROLINE HANNIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6400
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(978) 460-1323
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
208D00000X
General Practice Physician
0102209456
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/07/2024
Last updated
09/19/2025
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