Provider Demographics
NPI:1821282104
Name:7 HILLS HEALTH SERVICES
Entity Type:Organization
Organization Name:7 HILLS HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-945-7687
Mailing Address - Street 1:12500 BORON AVE
Mailing Address - Street 2:
Mailing Address - City:BORON
Mailing Address - State:CA
Mailing Address - Zip Code:93516-1647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12500 BORON AVE
Practice Address - Street 2:
Practice Address - City:BORON
Practice Address - State:CA
Practice Address - Zip Code:93516-1647
Practice Address - Country:US
Practice Address - Phone:760-762-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89858291U00000X, 302R00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1961Medicare UPIN