Provider Demographics
NPI:1609267582
Name:HALL, MATTHEW GENE HURRICANE (LCGC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GENE HURRICANE
Last Name:HALL
Suffix:
Gender:M
Credentials:LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1416
Mailing Address - Country:US
Mailing Address - Phone:650-721-5588
Mailing Address - Fax:650-725-9526
Practice Address - Street 1:211 QUARRY RD
Practice Address - Street 2:2ND FLOOR, M/C 5992
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1416
Practice Address - Country:US
Practice Address - Phone:650-721-5588
Practice Address - Fax:650-725-9526
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000588170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS