Healthcare Provider Details

I. General information

NPI: 1497931901
Provider Name (Legal Business Name): SUGINDA MARIE HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4395 70TH ST APT 43
LA MESA CA
91941-5937
US

IV. Provider business mailing address

4395 70TH ST APT 43
LA MESA CA
91942-5937
US

V. Phone/Fax

Practice location:
  • Phone: 760-717-5454
  • Fax:
Mailing address:
  • Phone: 760-717-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number230133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: