Provider Demographics
NPI:1942539432
Name:HALL, MARTHA ELENA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELENA
Last Name:HALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 W EL PORTAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4633
Mailing Address - Country:US
Mailing Address - Phone:949-510-6333
Mailing Address - Fax:949-366-1422
Practice Address - Street 1:131 W. EL PORTAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:949-510-6333
Practice Address - Fax:949-487-1992
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist