Healthcare Provider Details

I. General information

NPI: 1487639290
Provider Name (Legal Business Name): ILONA ANN BARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S PALISADE DR SUITE 104
SANTA MARIA CA
93454-8904
US

IV. Provider business mailing address

117 W BUNNY AVE
SANTA MARIA CA
93458-2805
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3957
  • Fax:
Mailing address:
  • Phone: 805-739-3474
  • Fax: 805-614-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA45912
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA45912
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA45912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: