Healthcare Provider Details

I. General information

NPI: 1528567427
Provider Name (Legal Business Name): PATRICK JOSEPH HALILI DNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE STE 200
LONG BEACH CA
90813-3266
US

IV. Provider business mailing address

5825 LINCOLN AVE STE D #112
BUENA PARK CA
90620-3474
US

V. Phone/Fax

Practice location:
  • Phone: 562-624-4999
  • Fax: 562-491-9128
Mailing address:
  • Phone: 562-542-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95008467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: