Healthcare Provider Details

I. General information

NPI: 1982518288
Provider Name (Legal Business Name): ALIYAH HALL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 FOOTHILL BLVD
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

2929 FLOYD AVE APT 135
MODESTO CA
95355-8769
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-9690
  • Fax:
Mailing address:
  • Phone: 925-503-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number763202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: