Healthcare Provider Details

I. General information

NPI: 1467614800
Provider Name (Legal Business Name): DAVID CHARLES HALL II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 CARMEL COUNTRY RD
SAN DIEGO CA
92130-2153
US

IV. Provider business mailing address

253 10TH AVE UNIT 1307
SAN DIEGO CA
92101-7453
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA99761
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA99761
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: