| Michael J Ilas Do A California Professional Medical Corp | |
|
34859 Fredrick Street Suite 111 Wildomar CA 92595 | |
| (562) 866-1895 | |
| (562) 866-5730 |
| Full Name | Michael J Ilas Do A California Professional Medical Corp |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 34859 Fredrick Street, Wildomar, California |
| Authorized Official Name and Position | Michael J Ilas (PROVIDER) |
| Authorized Official Contact | 5628661895 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael J Ilas Do A California Professional Medical Corp Po Box 892577 Temecula CA 92589-2577 Ph: (562) 866-1895 | Michael J Ilas Do A California Professional Medical Corp 34859 Fredrick Street Suite 111 Wildomar CA 92595 Ph: (562) 866-1895 |
| NPI Number | 1932287620 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932287620 | NPI | - | NPPES |
| 20A6560 | Other | CA | BLUE SHIELD |
| 00AX65601 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 20A6560 (California) | Primary |
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