Provider Demographics
NPI:1699051896
Name:HALL, LORNA BETH (PA)
Entity type:Individual
Prefix:MS
First Name:LORNA
Middle Name:BETH
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 1:10 SAN RAFAEL AVE
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2328
Mailing Address - Country:US
Mailing Address - Phone:415-713-9481
Mailing Address - Fax:
Practice Address - Street 1:1124 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-4331
Practice Address - Country:US
Practice Address - Phone:510-533-0800
Practice Address - Fax:510-533-0300
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant