Provider Demographics
NPI:1013020619
Name:HILL, LUCIUS JR JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:LUCIUS
Middle Name:JR
Last Name:HILL
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1738 N WATERMAN AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5131
Mailing Address - Country:US
Mailing Address - Phone:909-886-7700
Mailing Address - Fax:909-886-7707
Practice Address - Street 1:1738 N WATERMAN AVE
Practice Address - Street 2:STE 5
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5131
Practice Address - Country:US
Practice Address - Phone:909-886-7700
Practice Address - Fax:909-886-7707
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E29700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11535Medicare UPIN