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General NPI Number Information
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NPI Number | 1467506451
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Entity Type | Organization
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Legal Business Name | HALO MEDICAL GROUP
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 74785 US HIGHWAY 111 SUITE 101
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City | INDIAN WELLS
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State | CA
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Zip | 92210-7128
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Country | US
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Telephone | 760-776-8989
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Fax | 760-501-0311
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Provider Business Mailing Address
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Address Line | PO BOX 841163
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City | LOS ANGELES
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State | CA
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Zip | 90084-1163
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Country | US
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Telephone | 760-776-8989
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Fax | 760-779-8073
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Authorized Official
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Title or Position | CFO
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Name | CORY HAMMOND
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Credential |
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Telephone | 760-776-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | FNP25453
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License Number State | CA
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