Provider Demographics
NPI:1336731892
Name:CARVAJAL, HILLARY SAMANTHA
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:SAMANTHA
Last Name:CARVAJAL
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 1:51 TIERRA REJADA RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2902
Mailing Address - Country:US
Mailing Address - Phone:805-416-5791
Mailing Address - Fax:805-416-5792
Practice Address - Street 1:51 TIERRA REJADA RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2902
Practice Address - Country:US
Practice Address - Phone:805-416-5791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135969183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician