Provider Demographics
NPI:1245898261
Name:HILLMAN, EDWARD AMIR
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:AMIR
Last Name:HILLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:AMIR
Other - Last Name:HILLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8318 DOGBANE AVE APT F
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-1941
Mailing Address - Country:US
Mailing Address - Phone:323-301-8351
Mailing Address - Fax:
Practice Address - Street 1:16940 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1238
Practice Address - Country:US
Practice Address - Phone:661-824-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist