Provider Demographics
NPI:1912003252
Name:HILLCREST INTERNAL MEDICINE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HILLCREST INTERNAL MEDICINE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-298-1318
Mailing Address - Street 1:4060 4TH AVE
Mailing Address - Street 2:STE 505
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-298-1318
Mailing Address - Fax:619-298-0843
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:STE 505
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-298-1318
Practice Address - Fax:619-298-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086930Medicaid
CAW14788Medicare ID - Type Unspecified