Healthcare Provider Details

I. General information

NPI: 1831604008
Provider Name (Legal Business Name): KATHERINE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORANGE AVE # 101
CORONADO CA
92118-1408
US

IV. Provider business mailing address

7228 SANTA BARBARA ST
CARLSBAD CA
92011-4635
US

V. Phone/Fax

Practice location:
  • Phone: 619-840-2720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: