Healthcare Provider Details

I. General information

NPI: 1972728921
Provider Name (Legal Business Name): HALLOWELL-WEST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MARINE VIEW AVE SUITE 110
SOLANA BEACH CA
92075-2133
US

IV. Provider business mailing address

140 MARINE VIEW AVE SUITE 110
SOLANA BEACH CA
92075-2133
US

V. Phone/Fax

Practice location:
  • Phone: 858-350-4595
  • Fax: 858-350-4596
Mailing address:
  • Phone: 858-350-4595
  • Fax: 858-350-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberG50175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberA69151
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40523
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 17903
License Number StateCA

VIII. Authorized Official

Name: KENNETH A. SELZER
Title or Position: OWNER
Credential: M.D.
Phone: 858-350-4595