Provider Demographics
NPI:1962836676
Name:GILLAM, ORLANDO II
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:
Last Name:GILLAM
Suffix:II
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 1:4991 E MCKINLEY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1966
Mailing Address - Country:US
Mailing Address - Phone:559-981-2143
Mailing Address - Fax:
Practice Address - Street 1:4991 E MCKINLEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1966
Practice Address - Country:US
Practice Address - Phone:559-981-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510488527101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962637512OtherMEDI CAL