Provider Demographics
NPI:1639564677
Name:ROBILLARD, JAMES (CCP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ROBILLARD
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3533
Mailing Address - Country:US
Mailing Address - Phone:559-977-1041
Mailing Address - Fax:
Practice Address - Street 1:151 W JORDAN AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3533
Practice Address - Country:US
Practice Address - Phone:559-977-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760089242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist