Healthcare Provider Details

I. General information

NPI: 1215396395
Provider Name (Legal Business Name): VICTOR HILLAERT CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD
LOS ANGELES CA
90025-4749
US

IV. Provider business mailing address

30102 CHEVAL ST
MOUNT DORA FL
32757-7817
US

V. Phone/Fax

Practice location:
  • Phone: 310-850-8657
  • Fax:
Mailing address:
  • Phone: 443-880-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001152
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030939
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR199804
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9447760
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR199804
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: