Healthcare Provider Details

I. General information

NPI: 1316490121
Provider Name (Legal Business Name): ANTHONY HALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

IV. Provider business mailing address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax: 559-992-7102
Mailing address:
  • Phone: 559-992-7100
  • Fax: 559-992-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95004506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: