Healthcare Provider Details

I. General information

NPI: 1417942616
Provider Name (Legal Business Name): ILINA BERON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 S HOLT AVE
LOS ANGELES CA
90035-2009
US

IV. Provider business mailing address

1059 S HOLT AVE
LOS ANGELES CA
90035-2009
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-5678
  • Fax: 310-652-5369
Mailing address:
  • Phone: 310-657-5678
  • Fax: 310-652-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number456661
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number456661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: