MEDICARE: ALFRED ZIMBALIST HILL MPSS, SUDCC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14926	CA
2	175T00000X	Peer Specialist	MPSS-COSAFV	CA

General Provider Information

NPI Number	:	1962134189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED ZIMBALIST HILL MPSS, SUDCC

Provider Business Mailing Address
First Line	:	2012 ILLION ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1233
Country	:	US
Telephone Number	:	619-804-9716
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 IRIS AVE
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-3751
Country	:	US
Telephone Number	:	800-733-5627
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	11/04/2025

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