Healthcare Provider Details

I. General information

NPI: 1265590525
Provider Name (Legal Business Name): NILESH HINGARH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43845 10TH ST W 2A
LANCASTER CA
93534-4800
US

IV. Provider business mailing address

PO BOX 803335
SANTA CLARITA CA
91380-3335
US

V. Phone/Fax

Practice location:
  • Phone: 661-414-7677
  • Fax: 661-310-1686
Mailing address:
  • Phone: 661-414-7677
  • Fax: 661-310-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA80963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA80963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: