Basic Information
| Provider Information | |||||||||
| NPI: | 1467998849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALLAS | ||||||||
| FirstName: | JUSTINE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1711 W HENDERSON AVE | ||||||||
| Address2: | #93 | ||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932571588 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 PUTNAM AVE | ||||||||
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| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597813700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2017 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 95005059 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.