Willis, Mary Jane Hall

Willis, Mary Jane Hall is an individual health care provider with primary practice located at 34520 Bob Wilson Dr Suite 100, San Diego CA 92134-2098. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.), Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Willis, Mary Jane Hall can be contacted via phone (619) 532-6896.

Contact Information

Primary practice address
34520 Bob Wilson Dr Suite 100 San Diego CA 92134-2098
Phone: (619) 532-6896
Fax: (619) 532-9184
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) 207SG0201X A75301 California
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A75301 California

Profile Details

NPI number 1104998053
LBN Legal business name Willis, Mary Jane Hall
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2006
Last updated Mar 3rd, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104998053 NPPES
California MEDICAID 00A753010

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