Healthcare Provider Details

I. General information

NPI: 1407590128
Provider Name (Legal Business Name): ERIC HJALTALIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E PRATER WAY STE 215
SPARKS NV
89434-9634
US

IV. Provider business mailing address

2345 E PRATER WAY STE 215
SPARKS NV
89434-9634
US

V. Phone/Fax

Practice location:
  • Phone: 775-352-5301
  • Fax:
Mailing address:
  • Phone: 775-352-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO3922
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO3922
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: