Healthcare Provider Details

I. General information

NPI: 1669674065
Provider Name (Legal Business Name): CAROL A HILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E PELTASON
IRVINE CA
92697-0001
US

IV. Provider business mailing address

6592 E VIA CORRAL
ANAHEIM CA
92807-4310
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-5940
  • Fax: 949-824-3033
Mailing address:
  • Phone: 714-281-8259
  • Fax: 949-824-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number592566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: