Healthcare Provider Details

I. General information

NPI: 1154453777
Provider Name (Legal Business Name): MS. IREY DOLORES HILSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W MANCHESTER BLVD
INGLEWOOD CA
90305-2514
US

IV. Provider business mailing address

510 W 121ST ST
LOS ANGELES CA
90044-3909
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-0640
  • Fax: 323-777-6446
Mailing address:
  • Phone: 323-750-0640
  • Fax: 323-777-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: