Provider Demographics
NPI:1821080060
Name:HALL, ANNE V (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:V
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. CHURCH STREET
Mailing Address - Street 2:ATTENTION- MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-739-3954
Mailing Address - Fax:805-739-3060
Practice Address - Street 1:300 S STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5903
Practice Address - Country:US
Practice Address - Phone:805-739-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003456363A00000X
CA52181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD4799Medicare ID - Type Unspecified
NYR54881Medicare UPIN