MEDICARE: TOMMY HIERS LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	175858	CA

General Provider Information

NPI Number	:	1174883649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMY HIERS LVN

Provider Business Mailing Address
First Line	:	7682 MOCKING BIRD DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7682 MOCKING BIRD DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3302
Country	:	US
Telephone Number	:	858-210-2822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	05/18/2012

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