Provider Demographics
NPI:1649626177
Name:JOHNSTON, HILARY (PA-C, MMS)
Entity type:Individual
Prefix:MRS
First Name:HILARY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N SAN MATEO DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2778
Mailing Address - Country:US
Mailing Address - Phone:650-348-1242
Mailing Address - Fax:650-348-0788
Practice Address - Street 1:801 TRAEGER AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3048
Practice Address - Country:US
Practice Address - Phone:650-742-5969
Practice Address - Fax:650-742-7116
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical