Healthcare Provider Details

I. General information

NPI: 1982904264
Provider Name (Legal Business Name): ANA PAJOTA HALILI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 STARLIGHT GLN
ESCONDIDO CA
92026-3856
US

IV. Provider business mailing address

2433 STARLIGHT GLN
ESCONDIDO CA
92026-3856
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-9928
  • Fax:
Mailing address:
  • Phone: 760-591-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number31997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number380101061156417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: