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General NPI Number Information
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NPI Number | 1083927115
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Entity Type | Individual
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Provider Name | JILBERT ERADAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 10866 WILSHIRE BLVD SUITE 400 - PMB 278
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City | LOS ANGELES
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State | CA
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Zip | 90024-4300
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Country | US
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Telephone | 310-000-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 631 W AVENUE Q STE A
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City | PALMDALE
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State | CA
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Zip | 93551-3892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A107977
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A107977
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License Number State | CA
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