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NPI Code Detail

MEDICARE: MS. BERTHA M ILONGO NP

MEDICARE: MS. BERTHA M ILONGO NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374U00000XHome Health Aide
2163WP0808XPsychiatric/Mental Health Registered Nurse95233258CA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner95233258CA

General Provider Information

NPI Number : 1851659171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BERTHA M ILONGO NP
Provider Business Mailing Address
First Line : 2656 W CANYON AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-4684
Country : US
Telephone Number : 913-257-1824
Fax Number :
Provider Business Practice Location Address
First Line : 720 WOOD ST
Second Line :
City : EUREKA
State : CA
Zip : 95501-4413
Country : US
Telephone Number : 707-268-2990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2012
Last Update Date : 05/21/2024

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