Provider Demographics
NPI:1013416536
Name:NARCISO, HILTON LIM
Entity Type:Individual
Prefix:
First Name:HILTON
Middle Name:LIM
Last Name:NARCISO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26866 PETERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4326
Mailing Address - Country:US
Mailing Address - Phone:510-264-1628
Mailing Address - Fax:
Practice Address - Street 1:1970 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-8812
Practice Address - Country:US
Practice Address - Phone:209-830-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78172333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy