Healthcare Provider Details

I. General information

NPI: 1770307647
Provider Name (Legal Business Name): MR. ANDREW ARTHUR HALL I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 BEVERLY RD
PICO RIVERA CA
90660-2203
US

IV. Provider business mailing address

125 N AVENUE 56 APT 3
LOS ANGELES CA
90042-4146
US

V. Phone/Fax

Practice location:
  • Phone: 760-567-3852
  • Fax:
Mailing address:
  • Phone: 760-567-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: