Provider Demographics
NPI:1316148752
Name:HALL, RONALD R (MA, MA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:R
Last Name:HALL
Suffix:
Gender:M
Credentials:MA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S LINCOLN AVE STE 104 PMB 122
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3136
Mailing Address - Country:US
Mailing Address - Phone:951-272-4357
Mailing Address - Fax:
Practice Address - Street 1:750 S LINCOLN AVE STE 104 PMB 122
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3136
Practice Address - Country:US
Practice Address - Phone:951-272-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist