Healthcare Provider Details

I. General information

NPI: 1770466500
Provider Name (Legal Business Name): ANGELA GRINNELL-HALL HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 HERITAGE OAK PL STE 11
AUBURN CA
95603-2405
US

IV. Provider business mailing address

11990 HERITAGE OAK PL STE 11
AUBURN CA
95603-2405
US

V. Phone/Fax

Practice location:
  • Phone: 530-823-7532
  • Fax: 530-823-0316
Mailing address:
  • Phone: 530-823-7532
  • Fax: 530-823-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA9150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: