Healthcare Provider Details

I. General information

NPI: 1922029164
Provider Name (Legal Business Name): YVONNE D HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YVONNE D HALL-GOMEZ MD

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE 7
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

2003 SOUTHERN BLVD SE STE 102-214
RIO RANCHO NM
87124-3751
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-3982
  • Fax: 505-792-6060
Mailing address:
  • Phone: 505-515-3982
  • Fax: 505-792-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2003-0591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: