Healthcare Provider Details

I. General information

NPI: 1306950415
Provider Name (Legal Business Name): JOSEPH DAVID HILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

IV. Provider business mailing address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-7288
  • Fax:
Mailing address:
  • Phone: 949-499-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA84572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: