Healthcare Provider Details

I. General information

NPI: 1265545586
Provider Name (Legal Business Name): JOSE R. CILLIANI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S BRISTOL ST
SANTA ANA CA
92703-4527
US

IV. Provider business mailing address

420 S BRISTOL ST
SANTA ANA CA
92703-4527
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-5252
  • Fax: 714-541-1402
Mailing address:
  • Phone: 714-541-5252
  • Fax: 714-541-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: