Provider Demographics
NPI:1952823106
Name:RICHILEAU, RANDALL (CST)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:RICHILEAU
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10561 JEFFREYS ST STE 230
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4268
Mailing Address - Country:US
Mailing Address - Phone:702-565-6565
Mailing Address - Fax:702-990-5255
Practice Address - Street 1:10561 JEFFREYS ST STE 230
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4268
Practice Address - Country:US
Practice Address - Phone:702-565-6565
Practice Address - Fax:702-990-5255
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist