MEDICARE: DR. ILONA ANN BARAN MD

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	207V00000X	Obstetrics & Gynecology Physician	A45912	CA
2	207VG0400X	Gynecology Physician	A45912	CA
3	207VX0000X	Obstetrics Physician	A45912	CA

General Provider Information

NPI Number	:	1487639290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILONA ANN BARAN MD

Provider Business Mailing Address
First Line	:	117 W BUNNY AVE
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-2805
Country	:	US
Telephone Number	:	805-739-3474
Fax Number	:	805-614-5956

Provider Business Practice Location Address
First Line	:	116 S PALISADE DR
Second Line	:	SUITE 104
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-8904
Country	:	US
Telephone Number	:	805-739-3957
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	08/21/2014

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