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General NPI Number Information
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NPI Number | 1083057798
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Entity Type | Organization
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Legal Business Name | GENERAL K HILLIARD, M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 13847 E 14TH ST STE 203
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2626
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Country | US
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Telephone | 510-352-5325
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Fax | 510-351-7446
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Provider Business Mailing Address
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Address Line | 13847 E 14TH ST STE 203
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2626
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Country | US
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Telephone | 510-352-5325
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Fax | 510-351-7446
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Authorized Official
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Title or Position | BILLER
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Name | SHANNON VISCOVICH-BUSBY
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Credential |
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Telephone | 925-961-8920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00C32269
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License Number State | CA
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