Provider Demographics
NPI:1972350361
Name:HILL, QUEENIE (RD)
Entity type:Individual
Prefix:
First Name:QUEENIE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27632 RUBY LN
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3114
Mailing Address - Country:US
Mailing Address - Phone:510-499-5380
Mailing Address - Fax:
Practice Address - Street 1:27632 RUBY LN
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3114
Practice Address - Country:US
Practice Address - Phone:510-499-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered