Healthcare Provider Details

I. General information

NPI: 1497452502
Provider Name (Legal Business Name): HALO BREAST CARE CENTER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 ESPLANADE
CHICO CA
95926-3315
US

IV. Provider business mailing address

74785 HWY 111 SUITE 101
INDIAN WELLS CA
92210
US

V. Phone/Fax

Practice location:
  • Phone: 530-868-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN F FELLER
Title or Position: OWNER
Credential: MD
Phone: 530-898-0500