Healthcare Provider Details

I. General information

NPI: 1710562509
Provider Name (Legal Business Name): JEFF HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 17TH ST
BAKERSFIELD CA
93301-4504
US

IV. Provider business mailing address

1300 17TH ST
BAKERSFIELD CA
93301-4504
US

V. Phone/Fax

Practice location:
  • Phone: 661-852-5646
  • Fax:
Mailing address:
  • Phone: 661-852-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-54359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: