MEDICARE: DR. BRIAN ILIESCU LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSYC.PY.61366182	WA
2	103T00000X	Psychologist	PSY.0006625	CO

General Provider Information

NPI Number	:	1225408081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ILIESCU LP

Provider Business Mailing Address
First Line	:	3232 S NEWCOMBE ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5699
Country	:	US
Telephone Number	:	720-443-3038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 S NEWCOMBE ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5699
Country	:	US
Telephone Number	:	720-443-3038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	03/12/2026

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Directions to “ DR. BRIAN ILIESCU LP” Practice Location

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