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NPI Code Detail

MEDICARE: WHITNEY HALLECK

MEDICARE: WHITNEY HALLECK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA
2225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1700758752
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY HALLECK
Provider Business Mailing Address
First Line : 1260 MORENA BLVD STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3850
Country : US
Telephone Number : 619-398-0355
Fax Number :
Provider Business Practice Location Address
First Line : 1260 MORENA BLVD STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3850
Country : US
Telephone Number : 619-398-0355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2025
Last Update Date : 05/26/2026

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Directions to “ WHITNEY HALLECK ” Practice Location

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