Basic Information
Provider Information
NPI: 1356458616
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HLA
FirstName: NI NI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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Mailing Information
Address1: 3835 N FREEWAY BLVD STE 100
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958341954
CountryCode: US
TelephoneNumber: 9165767900
FaxNumber: 9162850338
Practice Location
Address1: 2180 HARVARD ST STE 210
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958153318
CountryCode: US
TelephoneNumber: 9165673500
FaxNumber: 9165673501
Other Information
ProviderEnumerationDate: 08/24/2006
LastUpdateDate: 03/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0804XAQ94426CAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
2084P0800XA94426CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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