Healthcare Provider Details

I. General information

NPI: 1972758407
Provider Name (Legal Business Name): ISABELLE C HALLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 02/04/2022
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 N COOLIDGE AVE
LOS ANGELES CA
90039-3411
US

IV. Provider business mailing address

1800 HARRISON ST 7TH FL
OAKLAND CA
94612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 323-666-8373
  • Fax:
Mailing address:
  • Phone: 707-651-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A10602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: