Healthcare Provider Details

I. General information

NPI: 1124359195
Provider Name (Legal Business Name): GREGG E HILL PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 100
FOOTHILL RANCH CA
92610-2843
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 100
FOOTHILL RANCH CA
92610-2843
US

V. Phone/Fax

Practice location:
  • Phone: 949-460-9111
  • Fax: 949-460-9055
Mailing address:
  • Phone: 949-460-9111
  • Fax: 949-460-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: