Healthcare Provider Details

I. General information

NPI: 1912270877
Provider Name (Legal Business Name): MR. ANTHONY LAMONT HINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 HERITAGE OAKS PLACE, SUITE 12
AUBURN CA
95603
US

IV. Provider business mailing address

4010 FOOTHILLS BOULEVARD, SUITE 104
ROSEVILLE CA
95747
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-8350
  • Fax: 530-885-7237
Mailing address:
  • Phone: 916-789-2050
  • Fax: 530-885-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 6089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: