Healthcare Provider Details

I. General information

NPI: 1194970541
Provider Name (Legal Business Name): ERYNNE NICOLE HILL MS, HHP, ATC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERYNNE NICOLE BROTHERTON HHP, ATC, LMT

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

IV. Provider business mailing address

3959 RUFFIN RD STE F
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-5570
  • Fax: 858-279-5303
Mailing address:
  • Phone: 858-279-5570
  • Fax: 858-279-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number070202254
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number07003020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: