Provider Demographics
NPI:1497952642
Name:STILLO, RICHARD V (LAC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:V
Last Name:STILLO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 W MORSE DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1658
Mailing Address - Country:US
Mailing Address - Phone:609-240-8338
Mailing Address - Fax:
Practice Address - Street 1:3207 W MORSE DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-1658
Practice Address - Country:US
Practice Address - Phone:609-240-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC011357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00055400OtherACUPUNCTURE LICENSE #