Healthcare Provider Details

I. General information

NPI: 1487970414
Provider Name (Legal Business Name): HARRY HILL JR. CERTIFICATION
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 PACIFIC AVE
LONG BEACH CA
90806-4610
US

IV. Provider business mailing address

481 W WILLOW ST
LONG BEACH CA
90806-2843
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-0023
  • Fax: 562-591-0071
Mailing address:
  • Phone: 562-424-6531
  • Fax: 562-424-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: