Provider Demographics
NPI:1568575447
Name:HILLCREST UROLOGICAL MEDICAL GRP.
Entity Type:Organization
Organization Name:HILLCREST UROLOGICAL MEDICAL GRP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERWERF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-888-7700
Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-888-7721
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-297-4707
Practice Address - Fax:619-297-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44719208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty