Provider Demographics
NPI:1447790605
Name:CUILLARD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CUILLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21148 E MUNOZ ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6765
Mailing Address - Country:US
Mailing Address - Phone:805-206-0924
Mailing Address - Fax:
Practice Address - Street 1:21148 E MUNOZ ST
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6765
Practice Address - Country:US
Practice Address - Phone:805-206-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE28449690OtherARIZONA DEPARTMENT OF HEALTH SERVICES