Healthcare Provider Details

I. General information

NPI: 1689332629
Provider Name (Legal Business Name): ISABEL HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 WILSHIRE BLVD
LOS ANGELES CA
90024-4689
US

IV. Provider business mailing address

1836 THE STRAND APT D
HERMOSA BEACH CA
90254-3417
US

V. Phone/Fax

Practice location:
  • Phone: 424-401-0705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: