Provider Demographics
NPI:1831210368
Name:HILLCREST GYNECOLOGY & OBSTETRICS
Entity type:Organization
Organization Name:HILLCREST GYNECOLOGY & OBSTETRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-297-4901
Mailing Address - Street 1:4045 3RD AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2132
Mailing Address - Country:US
Mailing Address - Phone:619-297-4901
Mailing Address - Fax:619-688-5994
Practice Address - Street 1:4045 3RD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2132
Practice Address - Country:US
Practice Address - Phone:619-297-4901
Practice Address - Fax:619-688-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68463207V00000X
CAG33037207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57305ZOtherBLUE SHIELD OF CA
CAA68463OtherMEDICAL LICENSE
CAG33037OtherMEDICAL LICENSE