Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0900X | Dermatopathologist | A21297 | CA |
Y | 207NS0135X | Procedural Dermatology | A21297 | CA |
NPI | 1437238839 |
---|---|
Provider Name | Ronald J. Hale |
First Address | Beverly Hills, CA 90210-1418 |
Second Address | Santa Monica, CA 90403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 06/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A82403 | (02) | CA |