MEDICARE: KIRSTIN HALL MS, BCBA

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	103K00000X	Behavior Analyst	1-09-9999	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-09-9999	OTHER		BACB

General Provider Information

NPI Number	:	1184943425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTIN HALL MS, BCBA

Provider Business Mailing Address
First Line	:	9257 LAKE MURRAY BLVD UNIT D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1400
Country	:	US
Telephone Number	:	619-871-5126
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 CAMINO DEL RIO S STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4016
Country	:	US
Telephone Number	:	888-616-0864
Fax Number	:	888-616-0864

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	09/21/2023

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