Provider Demographics
NPI:1598003725
Name:DAVID S. HALLEGUA, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID S. HALLEGUA, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HALLEGUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-0928
Mailing Address - Street 1:8641 WILSHIRE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2921
Mailing Address - Country:US
Mailing Address - Phone:310-652-0928
Mailing Address - Fax:310-659-2841
Practice Address - Street 1:8641 WILSHIRE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2900
Practice Address - Country:US
Practice Address - Phone:310-652-0928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID S. HALLEGUA, MD, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-23
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF30096OtherUPIN