MEDICARE: DR. RODERICK SEITES HALL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY15283	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 15283	CA

General Provider Information

NPI Number	:	1104821479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODERICK SEITES HALL PH.D.

Provider Business Mailing Address
First Line	:	1224 10TH ST
Second Line	:	STE 208
City	:	CORONADO
State	:	CA
Zip	:	92118-3420
Country	:	US
Telephone Number	:	619-437-0440
Fax Number	:	619-435-6040

Provider Business Practice Location Address
First Line	:	1224 10TH ST
Second Line	:	STE 208
City	:	CORONADO
State	:	CA
Zip	:	92118-3420
Country	:	US
Telephone Number	:	619-437-0440
Fax Number	:	619-435-6040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/11/2025

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