Provider Demographics
NPI:1326645391
Name:HYDER, H DIJON
Entity Type:Individual
Prefix:
First Name:H DIJON
Middle Name:
Last Name:HYDER
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 1:11824 DELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-1292
Mailing Address - Country:US
Mailing Address - Phone:760-662-0424
Mailing Address - Fax:
Practice Address - Street 1:15000 7TH ST STE 208C
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3853
Practice Address - Country:US
Practice Address - Phone:760-998-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver