Healthcare Provider Details

I. General information

NPI: 1568103869
Provider Name (Legal Business Name): OLIVIA JOSEPHINE HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA MANDILE

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ STE 420
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6232
  • Fax: 310-206-1035
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA189965
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA189965
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA189965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: