MEDICARE: CATHEARINE JENKINS HALL PHD

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	103G00000X	Clinical Neuropsychologist	PSY8239	CA

General Provider Information

NPI Number	:	1588694954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHEARINE JENKINS HALL PHD

Provider Business Mailing Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	STE. 130
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-367-1335
Fax Number	:	949-305-3380

Provider Business Practice Location Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	STE. 130
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-367-1335
Fax Number	:	949-305-3380

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/16/2015

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