Basic Information
Provider Information
NPI: 1417101965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: TIMOTHY
MiddleName: MCCAJOR
NamePrefix: DR.
NameSuffix:  
Credential: MD, PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1920 COLORADO AVE
Address2:  
City: SANTA MONICA
State: CA
PostalCode: 904043414
CountryCode: US
TelephoneNumber: 3103194700
FaxNumber: 3104535106
Other Information
ProviderEnumerationDate: 11/11/2008
LastUpdateDate: 12/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XA108863CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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