Healthcare Provider Details

I. General information

NPI: 1972188563
Provider Name (Legal Business Name): DENISE M. HILLIARD, MD MEDICAL CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LA CASA VIA STE 205
WALNUT CREEK CA
94598-3017
US

IV. Provider business mailing address

110 LA CASA VIA STE 205
WALNUT CREEK CA
94598-3017
US

V. Phone/Fax

Practice location:
  • Phone: 925-464-3916
  • Fax: 925-954-7575
Mailing address:
  • Phone: 925-464-3916
  • Fax: 925-954-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE MARIA HILLIARD
Title or Position: OWNER
Credential: MD
Phone: 925-464-3916