Healthcare Provider Details

I. General information

NPI: 1467998849
Provider Name (Legal Business Name): JUSTINE HALLAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PUTNAM AVE
PORTERVILLE CA
93257
US

IV. Provider business mailing address

1711 W HENDERSON AVE #93
PORTERVILLE CA
93257-1588
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95005059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: