Healthcare Provider Details

I. General information

NPI: 1447952031
Provider Name (Legal Business Name): PRESTON HALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE A208
ENCINITAS CA
92024-1329
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-479-3900
  • Fax: 760-753-8177
Mailing address:
  • Phone: 760-479-3900
  • Fax: 760-753-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA206938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: