Provider Demographics
NPI:1336329499
Name:HILLEBERT, DAVID JONATHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHAN
Last Name:HILLEBERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9635 SUNNYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96062-9505
Mailing Address - Country:US
Mailing Address - Phone:530-547-2004
Mailing Address - Fax:530-547-2004
Practice Address - Street 1:1100 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0852
Practice Address - Country:US
Practice Address - Phone:530-244-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14835363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical