Provider Demographics
NPI:1124359195
Name:HILL, GREGG E (PAC)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:E
Last Name:HILL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:26700 TOWNE CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2843
Mailing Address - Country:US
Mailing Address - Phone:949-460-9111
Mailing Address - Fax:949-460-9055
Practice Address - Street 1:26700 TOWNE CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2843
Practice Address - Country:US
Practice Address - Phone:949-460-9111
Practice Address - Fax:949-460-9055
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical