Provider Demographics
NPI:1407215015
Name:HALL, JOHANNA JESSICA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:JESSICA
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JOHANNA
Other - Middle Name:JESSICA
Other - Last Name:HALL-BEDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:119 LOS PADRES LN
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 LOS PADRES LN
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6232
Practice Address - Country:US
Practice Address - Phone:626-378-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant