Healthcare Provider Details

I. General information

NPI: 1366907461
Provider Name (Legal Business Name): ELIZABETH HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CHRISTINE AVINA

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 650-934-7660
  • Fax:
Mailing address:
  • Phone: 650-934-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95012589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: