Healthcare Provider Details

I. General information

NPI: 1821732363
Provider Name (Legal Business Name): SHANE OLIVER HALL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 TARA HILLS DR STE 103
PINOLE CA
94564-2536
US

IV. Provider business mailing address

1320 TARA HILLS DR STE 103
PINOLE CA
94564-2536
US

V. Phone/Fax

Practice location:
  • Phone: 925-979-8313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: