Healthcare Provider Details

I. General information

NPI: 1386256105
Provider Name (Legal Business Name): HALEE MARIE BOOTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEE MICHEL

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 VALLEY CENTRE DR
SAN DIEGO CA
92130-3318
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-764-3150
  • Fax:
Mailing address:
  • Phone: 858-764-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58265
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA58265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: