Healthcare Provider Details

I. General information

NPI: 1174465249
Provider Name (Legal Business Name): MATTHEW HALL RN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

6639 1/2 AMHERST ST
SAN DIEGO CA
92115-2905
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95250722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: