Provider Demographics
NPI:1093276461
Name:AVERA, HILLARY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:AVERA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28780 SINGLE OAK DR STE 260
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5534
Mailing Address - Country:US
Mailing Address - Phone:951-676-4193
Mailing Address - Fax:
Practice Address - Street 1:41238 MARGARITA RD STE 106
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5552
Practice Address - Country:US
Practice Address - Phone:760-780-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56645208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics