Provider Demographics
NPI:1235969486
Name:HAMILTON, DAVID (PMHNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9443 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6106
Mailing Address - Country:US
Mailing Address - Phone:909-253-3854
Mailing Address - Fax:
Practice Address - Street 1:1902 ORANGE TREE LN STE 200
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2800
Practice Address - Country:US
Practice Address - Phone:909-798-6200
Practice Address - Fax:909-798-6210
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031475363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health