Provider Demographics
NPI:1003885427
Name:HILDEBRAND, RYAN STEPHEN (IDC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:STEPHEN
Last Name:HILDEBRAND
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:BLDG 3005 SR 108
Mailing Address - Street 2:ATTN MEDICAL CLINIC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:93517
Mailing Address - Country:US
Mailing Address - Phone:760-932-1614
Mailing Address - Fax:
Practice Address - Street 1:BLDG 3005
Practice Address - Street 2:S R 108
Practice Address - City:BRIDGEPORT
Practice Address - State:CA
Practice Address - Zip Code:93517
Practice Address - Country:US
Practice Address - Phone:760-932-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians