Healthcare Provider Details

I. General information

NPI: 1659406080
Provider Name (Legal Business Name): MR. JAMES NICHOLAS HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 EL CAMINO REAL
SAN CARLOS CA
94070-5208
US

IV. Provider business mailing address

1692 EL CAMINO REAL
SAN CARLOS CA
94070-5208
US

V. Phone/Fax

Practice location:
  • Phone: 650-817-9070
  • Fax: 650-817-9074
Mailing address:
  • Phone: 650-817-9070
  • Fax: 650-817-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: