Healthcare Provider Details

I. General information

NPI: 1194068031
Provider Name (Legal Business Name): JACOB NICHOLAS HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25186 HANCOCK AVE STE 110
MURRIETA CA
92562-5998
US

IV. Provider business mailing address

25186 HANCOCK AVE STE 110
MURRIETA CA
92562-5998
US

V. Phone/Fax

Practice location:
  • Phone: 951-462-4624
  • Fax: 951-462-4625
Mailing address:
  • Phone: 951-462-4624
  • Fax: 951-462-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA132420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA132420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: