Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY15283 | CA |
N | 103TC0700X | Clinical Psychologist | PSY15283 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 15283 | CA |
NPI | 1104821479 |
---|---|
Provider Name | Dr. Roderick Seites Hall |
First Address | Coronado, CA 92118-3420 |
Second Address | Coronado, CA 92118-3420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/07/2007 |