Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP95001565 | CA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP95001565 | CA |
NPI | 1023408986 |
---|---|
Provider Name | Mandy Hillmer |
First Address | San Diego, CA 92127-5705 |
Second Address | San Diego, CA 92130-3318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2015 |
Last Update Date | 10/06/2021 |