Provider Demographics
NPI:1811860802
Name:HALL, TERISA MARIE (MEDI-CAL CPSS, RADT)
Entity type:Individual
Prefix:
First Name:TERISA
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:MEDI-CAL CPSS, RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3286 E GUASTI RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8646
Mailing Address - Country:US
Mailing Address - Phone:909-476-2023
Mailing Address - Fax:855-702-2557
Practice Address - Street 1:3286 E GUASTI RD STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8646
Practice Address - Country:US
Practice Address - Phone:909-476-2023
Practice Address - Fax:855-702-2557
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist