Healthcare Provider Details

I. General information

NPI: 1548875255
Provider Name (Legal Business Name): CHARLEE HALLER LM, CPM, MSM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 QUAIL VALLEY RUN
OAKLEY CA
94561-3425
US

IV. Provider business mailing address

1455 QUAIL VALLEY RUN
OAKLEY CA
94561-3425
US

V. Phone/Fax

Practice location:
  • Phone: 925-550-3699
  • Fax: 925-420-7337
Mailing address:
  • Phone: 925-550-3699
  • Fax: 925-420-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: