Provider Demographics
NPI:1265606685
Name:GREGORY W. HALL, MA
Entity type:Organization
Organization Name:GREGORY W. HALL, MA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:760-471-1196
Mailing Address - Street 1:910 W SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1115
Mailing Address - Country:US
Mailing Address - Phone:760-471-1196
Mailing Address - Fax:760-471-1550
Practice Address - Street 1:910 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1115
Practice Address - Country:US
Practice Address - Phone:760-471-1196
Practice Address - Fax:760-471-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU873261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAUD873Medicare UPIN