Healthcare Provider Details

I. General information

NPI: 1780767699
Provider Name (Legal Business Name): AMELIA LUZ PATRICIO HALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE EOB / PMRT SA3,10TH FLOOR
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

550 S VERMONT AVE EOB / PMRT SA3,10TH FLOOR
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-2004
  • Fax: 626-455-0623
Mailing address:
  • Phone: 626-258-2004
  • Fax: 626-455-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number352862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: