Provider Demographics
NPI:1619364684
Name:HILLYER, TONY
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:HILLYER
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 1:1963 SUMMERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-4076
Mailing Address - Country:US
Mailing Address - Phone:209-345-2669
Mailing Address - Fax:209-812-1775
Practice Address - Street 1:1963 SUMMERGLEN DR
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4076
Practice Address - Country:US
Practice Address - Phone:209-617-1516
Practice Address - Fax:209-812-1775
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)