Healthcare Provider Details

I. General information

NPI: 1104996263
Provider Name (Legal Business Name): PERRY ELLIOTT HILLBURG D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 OAK HOLLOW RD
CLAREMONT CA
91711-2331
US

IV. Provider business mailing address

4231 OAK HOLLOW RD
CLAREMONT CA
91711-2331
US

V. Phone/Fax

Practice location:
  • Phone: 909-593-7121
  • Fax:
Mailing address:
  • Phone: 909-593-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: