Provider Demographics
NPI:1134802952
Name:YILLA, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:YILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5954
Mailing Address - Country:US
Mailing Address - Phone:301-377-3043
Mailing Address - Fax:410-946-2010
Practice Address - Street 1:628 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5954
Practice Address - Country:US
Practice Address - Phone:301-377-3043
Practice Address - Fax:410-946-2010
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200002931374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide