Provider Demographics
NPI:1265545586
Name:CILLIANI, JOSE R (DO)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:CILLIANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4527
Mailing Address - Country:US
Mailing Address - Phone:714-541-5252
Mailing Address - Fax:714-541-1402
Practice Address - Street 1:420 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4527
Practice Address - Country:US
Practice Address - Phone:714-541-5252
Practice Address - Fax:714-541-1402
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX88520Medicaid