Provider Demographics
NPI:1003933276
Name:HILTGEN, DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:HILTGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25961 HIGHLAND WAY
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-9755
Mailing Address - Country:US
Mailing Address - Phone:408-353-4270
Mailing Address - Fax:
Practice Address - Street 1:2516 SAMARITAN DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4108
Practice Address - Country:US
Practice Address - Phone:408-656-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-269932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G269930Medicaid
CA00G269930Medicaid
00G269930Medicare ID - Type Unspecified