Provider Demographics
NPI:1861468134
Name:FAUSETT, HILARY J (MD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:J
Last Name:FAUSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CONGRESS ST
Mailing Address - Street 2:#303
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3024
Mailing Address - Country:US
Mailing Address - Phone:626-440-5900
Mailing Address - Fax:626-440-5900
Practice Address - Street 1:39 CONGRESS ST
Practice Address - Street 2:#303
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3024
Practice Address - Country:US
Practice Address - Phone:626-440-5900
Practice Address - Fax:626-440-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85360207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G853600Medicaid
CA00G853600Medicaid
G85360Medicare ID - Type Unspecified