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NPI Code Detail

MEDICARE: DAVID S HALLEGUA M.D., A PROFESSIONAL CORPORATION

MEDICARE: DAVID S HALLEGUA M.D., A PROFESSIONAL CORPORATION
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
1207RR0500XRheumatology PhysicianCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GU602ZOTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1639256894
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID S HALLEGUA M.D., A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 8641 WILSHIRE BLVD
Second Line : STE 301
City : BEVERLY HILLS
State : CA
Zip : 90211-2900
Country : US
Telephone Number : 310-652-0928
Fax Number : 310-659-2841
Provider Business Practice Location Address
First Line : 8641 WILSHIRE BLVD
Second Line : STE 301
City : BEVERLY HILLS
State : CA
Zip : 90211-2921
Country : US
Telephone Number : 310-652-0928
Fax Number : 310-659-2841
Authorized Official
Title or Position : OWNER
Name : DR. DAVID S HALLEGUA
Credential : MD
Telephone Number : 310-652-0928
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/17/2020

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