=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104904093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HILLARY GREEN REDLIN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 03/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 TAMALPAIS DR STE 310
-----------------------------------------------------
City | CORTE MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94925-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-886-8538
-----------------------------------------------------
Fax | 415-886-8537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 TERRACE AVE
-----------------------------------------------------
City | KENTFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-203-5701
-----------------------------------------------------
Fax | 415-886-8537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A70776
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------