Individual
DR. STANLEY JAMES TILLINGHAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2413 RIVENDELL LN, DAVIS, CA 95616-3058
(650) 400-3105
Mailing address
2413 RIVENDELL LN, DAVIS, CA 95616-3058
(650) 400-3105
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
15000
HI
207RC0000X
Cardiovascular Disease Physician
Primary
G039776
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000282038
HMSA BILLING NUMBER
HI
05
—
629917-01
—
HI
Enumeration date
03/01/2007
Last updated
04/24/2009
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