Provider Demographics
NPI:1225217169
Name:PAULINE HILTON ADVANCED PRACTICE NURSING SERVICES, INC
Entity Type:Organization
Organization Name:PAULINE HILTON ADVANCED PRACTICE NURSING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, MSN
Authorized Official - Phone:909-381-0803
Mailing Address - Street 1:1329 N H ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-5039
Mailing Address - Country:US
Mailing Address - Phone:909-381-0803
Mailing Address - Fax:909-381-0823
Practice Address - Street 1:1329 N H ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-5039
Practice Address - Country:US
Practice Address - Phone:909-381-0803
Practice Address - Fax:909-381-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-28
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3049994261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06454ZMedicare PIN