Healthcare Provider Details

I. General information

NPI: 1063318863
Provider Name (Legal Business Name): HALLA IRENE TAITANO HAMMOUDEH CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2026
Last Update Date: 10/19/2026
Certification Date: 10/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST
SAN FRANCISCO CA
94108-4206
US

IV. Provider business mailing address

464 43RD AVE APT C
SAN FRANCISCO CA
94121-1578
US

V. Phone/Fax

Practice location:
  • Phone: 707-547-7183
  • Fax:
Mailing address:
  • Phone: 707-547-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: