Healthcare Provider Details

I. General information

NPI: 1780954503
Provider Name (Legal Business Name): ELISSA HALLEN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ DIABETES CENTER ROOM 230
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

229 CRAUT ST
SAN FRANCISCO CA
94112-1503
US

V. Phone/Fax

Practice location:
  • Phone: 415-533-9293
  • Fax: 415-641-6829
Mailing address:
  • Phone: 415-533-9293
  • Fax: 415-641-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number422033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: