Provider Demographics
NPI:1558977033
Name:HILL, BRYCE RICHARD
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:RICHARD
Last Name:HILL
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 1:44658 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4030
Mailing Address - Country:US
Mailing Address - Phone:714-749-6090
Mailing Address - Fax:
Practice Address - Street 1:44658 FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4030
Practice Address - Country:US
Practice Address - Phone:714-749-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty