Healthcare Provider Details

I. General information

NPI: 1669866083
Provider Name (Legal Business Name): CHARLES RICHARD HILL PHD HYPNOTHERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34101 FARENHOLT AVE SUIT 228
SAN DIEGO CA
92134-5291
US

IV. Provider business mailing address

34101 FARENHOLT AVE SUIT 228
SAN DIEGO CA
92134-5291
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-5425
  • Fax:
Mailing address:
  • Phone: 619-532-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 67423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCHT689-504
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number38000086A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: