Provider Demographics
NPI:1497039275
Name:HILL, LARRY (HIS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 N MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-2553
Mailing Address - Country:US
Mailing Address - Phone:530-842-3181
Mailing Address - Fax:
Practice Address - Street 1:544 N MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2553
Practice Address - Country:US
Practice Address - Phone:530-842-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 1720237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist