=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730471699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ILANA KATSNELSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 GELLERT BLVD STE 119
-----------------------------------------------------
City | DALY CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94015-2690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-361-6212
-----------------------------------------------------
Fax | 415-480-8443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 GELLERT BLVD STE 119
-----------------------------------------------------
City | DALY CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94015-2690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-361-6212
-----------------------------------------------------
Fax | 415-480-8443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A56327
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | A56327
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------