Basic Information
| Provider Information | |||||||||
| NPI: | 1730525478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANGELICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1328 SECOND STREET | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105761308 | ||||||||
| FaxNumber: | 3105761057 | ||||||||
| Practice Location | |||||||||
| Address1: | 1328 SECOND STREET | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105761308 | ||||||||
| FaxNumber: | 3105761057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2013 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN260916 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.