Healthcare Provider Details

I. General information

NPI: 1588824361
Provider Name (Legal Business Name): HAL YINGLING PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9164 DESCHUTES RD SUITE F
PALO CEDRO CA
96073-8732
US

IV. Provider business mailing address

191 HARTNELL AVE
REDDING CA
96002-1841
US

V. Phone/Fax

Practice location:
  • Phone: 530-547-4477
  • Fax: 530-547-1056
Mailing address:
  • Phone: 530-223-7799
  • Fax: 530-222-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: