Healthcare Provider Details

I. General information

NPI: 1124117064
Provider Name (Legal Business Name): ESTELA C. ILAGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD SUITE # 208
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

5527 SAMANTHA AVE
LAKEWOOD CA
90712-1445
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0677
  • Fax:
Mailing address:
  • Phone: 562-602-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA51457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: