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General NPI Number Information
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NPI Number | 1366654568
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Entity Type | Organization
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Legal Business Name | ILONA ABRAHAM MD INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 17815 VENTURA BLVD SUITE 113
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City | ENCINO
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State | CA
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Zip | 91316-3610
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Country | US
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Telephone | 818-345-8721
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Fax | 818-345-7150
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Provider Business Mailing Address
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Address Line | 17815 VENTURA BLVD SUITE 113
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City | ENCINO
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State | CA
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Zip | 91316-3610
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Country | US
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Telephone | 818-345-8721
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Fax | 818-345-7150
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Authorized Official
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Title or Position | PRESIDENT
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Name | ILONA ABRAHAM
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Credential | MD
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Telephone | 818-345-8721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A25564
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License Number State | CA
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