Provider Demographics
NPI:1669897278
Name:HILLERMAN, CATHERINE (LAC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:HILLERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 OLD HARBOR LN APT 107
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7335
Mailing Address - Country:US
Mailing Address - Phone:425-283-8878
Mailing Address - Fax:310-423-0154
Practice Address - Street 1:2901 WILSHIRE BLVD STE 233
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4937
Practice Address - Country:US
Practice Address - Phone:425-283-8878
Practice Address - Fax:310-423-0154
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15778171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist