Healthcare Provider Details

I. General information

NPI: 1548344641
Provider Name (Legal Business Name): JEANETTE ILARDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 TELEPHONE RD STE 212
VENTURA CA
93003-5569
US

IV. Provider business mailing address

5767 W CENTURY BLVD
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-9121
  • Fax: 805-642-6283
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA49030
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA49030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: