Provider Demographics
NPI:1346618071
Name:O'HALLORAN, ELLEN HUCAL (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:HUCAL
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620B SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2535
Mailing Address - Country:US
Mailing Address - Phone:408-464-9619
Mailing Address - Fax:
Practice Address - Street 1:620B SUMNER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2535
Practice Address - Country:US
Practice Address - Phone:408-464-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant