Provider Demographics
NPI:1336643881
Name:ANNA HALBEISEN, D.O., P.C.
Entity Type:Organization
Organization Name:ANNA HALBEISEN, D.O., P.C.
Other - Org Name:ANNA HALBEISEN, D.O., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYISICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HALBEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-972-5533
Mailing Address - Street 1:3706 RUFFIN RD # 129
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1812
Mailing Address - Country:US
Mailing Address - Phone:858-587-1822
Mailing Address - Fax:
Practice Address - Street 1:3706 RUFFIN RD # 129
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1812
Practice Address - Country:US
Practice Address - Phone:858-587-1822
Practice Address - Fax:858-587-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12902261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty