Healthcare Provider Details

I. General information

NPI: 1659330645
Provider Name (Legal Business Name): JOHN MARK HILINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN M HILINSKI M.D.

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 4TH AVE
SAN DIEGO CA
92103-4203
US

IV. Provider business mailing address

3720 4TH AVE
SAN DIEGO CA
92103-4203
US

V. Phone/Fax

Practice location:
  • Phone: 619-296-3223
  • Fax: 619-296-3224
Mailing address:
  • Phone: 619-296-3223
  • Fax: 619-296-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA063027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: