Healthcare Provider Details

I. General information

NPI: 1588949119
Provider Name (Legal Business Name): JIM C BILLURIS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 SANTA INEZ DR
SAN JOSE CA
95125-5329
US

IV. Provider business mailing address

1842 ESTATES DR UNIT A
MONTROSE CO
81401-7134
US

V. Phone/Fax

Practice location:
  • Phone: 805-395-0448
  • Fax:
Mailing address:
  • Phone: 805-395-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: