Provider Demographics
NPI:1801999602
Name:WARREN, HILLIS LYNN (MD)
Entity type:Individual
Prefix:
First Name:HILLIS
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 HURLEY WAY
Mailing Address - Street 2:STE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3789
Mailing Address - Country:US
Mailing Address - Phone:916-453-1111
Mailing Address - Fax:916-483-4506
Practice Address - Street 1:2620 HURLEY WAY
Practice Address - Street 2:STE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3789
Practice Address - Country:US
Practice Address - Phone:916-929-1838
Practice Address - Fax:916-929-1753
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG030438174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G304380Medicaid
CA00G304380Medicaid
00G304380Medicare ID - Type Unspecified