Healthcare Provider Details

I. General information

NPI: 1376527804
Provider Name (Legal Business Name): ROSEMARY HALLETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E. HEALTH SCIENCES DR SUITE 6510
DAVIS CA
95616-8660
US

IV. Provider business mailing address

451 E. HEALTH SCIENCES DR SUITE 6510
DAVIS CA
95616-8660
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-2884
  • Fax: 530-754-6047
Mailing address:
  • Phone: 530-752-2884
  • Fax: 530-754-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA71662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: