Provider Demographics
NPI:1962134189
Name:HILL, ALFRED ZIMBALIST (MPSS, SUDCC)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:ZIMBALIST
Last Name:HILL
Suffix:
Gender:M
Credentials:MPSS, SUDCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 ILLION ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1233
Mailing Address - Country:US
Mailing Address - Phone:619-804-9716
Mailing Address - Fax:
Practice Address - Street 1:1325 IRIS AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-3751
Practice Address - Country:US
Practice Address - Phone:800-733-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14926101YA0400X
CAMPSS-COSAFV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist