Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY5552 | CA |
Y | 103T00000X | Psychologist | PSY5552 | CA |
NPI | 1013003565 |
---|---|
Provider Name | Dr. Edward E. Hall |
First Address | Sacramento, CA 95816-3362 |
Second Address | Sacramento, CA 95816-3362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R26303 | (02) | CA |