Provider Demographics
NPI:1629370150
Name:HILL, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15923 BEAR VALLEY RD
Mailing Address - Street 2:#A130 PMB#160
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1750
Mailing Address - Country:US
Mailing Address - Phone:760-486-6428
Mailing Address - Fax:909-510-8218
Practice Address - Street 1:15923 BEAR VALLEY RD
Practice Address - Street 2:#A130 PMB#160
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1750
Practice Address - Country:US
Practice Address - Phone:760-486-6428
Practice Address - Fax:909-510-8218
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography