Healthcare Provider Details

I. General information

NPI: 1568274272
Provider Name (Legal Business Name): SETH HAMILTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE SUITE 220
MONROVIA CA
91016-4066
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax: 999-999-9999
Mailing address:
  • Phone: 818-241-6780
  • Fax: 888-588-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: