Healthcare Provider Details

I. General information

NPI: 1982776837
Provider Name (Legal Business Name): ILANA S AMOS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 E CESAR E CHAVEZ AVE C-225
LOS ANGELES CA
90033-2400
US

IV. Provider business mailing address

1828 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2400
US

V. Phone/Fax

Practice location:
  • Phone: 323-261-0259
  • Fax: 323-261-0073
Mailing address:
  • Phone: 323-261-0259
  • Fax: 323-261-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA74397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: