Healthcare Provider Details

I. General information

NPI: 1316083389
Provider Name (Legal Business Name): MR. BILLY FRANK ELLIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 KIDDER AVENUE ASSIST SOLANO OUTPATIENT SERVICES
FAIRFIELD CA
94533-3919
US

IV. Provider business mailing address

2001 THE ALAMEDA ALLIANCE FOR COMMUNITY CARE
SAN JOSE CA
95126-1136
US

V. Phone/Fax

Practice location:
  • Phone: 707-425-2741
  • Fax: 707-425-2862
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-254-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: