Provider Demographics
NPI:1912074212
Name:HILL, S IRENA (PHD)
Entity Type:Individual
Prefix:
First Name:S IRENA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6428
Mailing Address - Country:US
Mailing Address - Phone:714-392-4902
Mailing Address - Fax:562-596-4380
Practice Address - Street 1:17612 BEACH BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6873
Practice Address - Country:US
Practice Address - Phone:714-841-1216
Practice Address - Fax:562-596-4380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist