Healthcare Provider Details

I. General information

NPI: 1013020619
Provider Name (Legal Business Name): LUCIUS JR HILL JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 N WATERMAN AVE STE 5
SAN BERNARDINO CA
92404-5131
US

IV. Provider business mailing address

1738 N WATERMAN AVE STE 5
SAN BERNARDINO CA
92404-5131
US

V. Phone/Fax

Practice location:
  • Phone: 909-886-7700
  • Fax: 909-886-7707
Mailing address:
  • Phone: 909-886-7700
  • Fax: 909-886-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000E29700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: