Healthcare Provider Details

I. General information

NPI: 1962495671
Provider Name (Legal Business Name): MARK HILBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3552
US

IV. Provider business mailing address

PO BOX 660877
SACRAMENTO CA
95866-0877
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-6800
  • Fax: 916-481-1881
Mailing address:
  • Phone: 916-481-6800
  • Fax: 916-481-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG16206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: