Provider Demographics
NPI:1477041473
Name:HILLER, ANDREW TIMOTHY (IDC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TIMOTHY
Last Name:HILLER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555381
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5381
Mailing Address - Country:US
Mailing Address - Phone:760-725-8805
Mailing Address - Fax:
Practice Address - Street 1:520445 SAN JUAN RD
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON NORTH
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-763-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman