Provider Demographics
NPI:1982476479
Name:KIL, PAUL (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KIL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3660 PARK SIERRA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:
Practice Address - Street 1:401 E HIGHLAND AVE STE 551
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3840
Practice Address - Country:US
Practice Address - Phone:909-882-9150
Practice Address - Fax:909-883-8972
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95027690363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner