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NPI Code Detail

MEDICARE: HALLIE PETTIBONE

MEDICARE: HALLIE PETTIBONE
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1316806029
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALLIE PETTIBONE
Provider Business Mailing Address
First Line : 110 RYAN INDUSTRIAL CT STE 3&4
Second Line :
City : SAN RAMON
State : CA
Zip : 94583-1592
Country : US
Telephone Number : 510-315-6600
Fax Number :
Provider Business Practice Location Address
First Line : 110 RYAN INDUSTRIAL CT STE 3&4
Second Line :
City : SAN RAMON
State : CA
Zip : 94583-1592
Country : US
Telephone Number : 510-315-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ HALLIE PETTIBONE ” Practice Location

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