Healthcare Provider Details

I. General information

NPI: 1578649067
Provider Name (Legal Business Name): SUSAN HALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432A WEST J STREET
TEHACHAPI CA
93561
US

IV. Provider business mailing address

PO BOX 2357
TEHACHAPI CA
93581-2357
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4421
  • Fax: 661-822-6250
Mailing address:
  • Phone: 661-822-4421
  • Fax: 661-822-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: