Provider Demographics
NPI:1003829060
Name:DRANGE HALLMAN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DRANGE HALLMAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLYS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:626-795-2663
Mailing Address - Street 1:2029 VERDUGO BLVD # 781
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1626
Mailing Address - Country:US
Mailing Address - Phone:626-795-2663
Mailing Address - Fax:973-425-5657
Practice Address - Street 1:301 S FAIR OAKS AVE STE 105
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:626-795-2663
Practice Address - Fax:973-425-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G85638207N00000X
CAA54654207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ05777ZOtherBLUE SHIELD PROVIDER NO
=========OtherBLUE CROSS PROVIDER NO
ZZZ05777ZOtherBLUE SHIELD PROVIDER NO