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General NPI Number Information
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NPI Number | 1932287620
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Entity Type | Organization
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Legal Business Name | MICHAEL J ILAS DO A CALIFORNIA PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34859 FREDRICK STREET SUITE 111
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 562-866-1895
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Fax | 562-866-5730
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Provider Business Mailing Address
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Address Line | PO BOX 892577
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City | TEMECULA
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State | CA
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Zip | 92589-2577
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Country | US
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Telephone | 562-866-1895
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Fax | 562-866-5730
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Authorized Official
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Title or Position | PROVIDER
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Name | MICHAEL J ILAS
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Credential | DO
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Telephone | 562-866-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A6560
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License Number State | CA
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