Healthcare Provider Details

I. General information

NPI: 1598003725
Provider Name (Legal Business Name): DAVID S. HALLEGUA, MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD SUITE 301
BEVERLY HILLS CA
90211-2900
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 301
BEVERLY HILLS CA
90211-2921
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-0928
  • Fax:
Mailing address:
  • Phone: 310-652-0928
  • Fax: 310-659-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID S. HALLEGUA
Title or Position: PRESIDENT
Credential: MD
Phone: 310-652-0928