Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000E29700 | CA |
Y | 222Z00000X | Podiatrist | 000E29700 | CA |
NPI | 1013020619 |
---|---|
Provider Name | Dr. Lucius Jr Hill JR. |
First Address | San Bernardino, CA 92404-5131 |
Second Address | San Bernardino, CA 92404-5131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11535 | (02) |