Healthcare Provider Details

I. General information

NPI: 1154950236
Provider Name (Legal Business Name): HALO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/21/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 ESPLANADE
CHICO CA
95926-3315
US

IV. Provider business mailing address

74785 HIGHWAY 111 SUITE 101
INDIAN WELLS CA
92210
US

V. Phone/Fax

Practice location:
  • Phone: 530-898-0504
  • Fax:
Mailing address:
  • Phone: 760-776-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CORY HAMMOND
Title or Position: CFO
Credential:
Phone: 760-776-8989