1417199969 NPI number — DR. EARL PEREZ ILANO MD

Table of content: DR. EARL PEREZ ILANO MD (NPI 1417199969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417199969 NPI number — DR. EARL PEREZ ILANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILANO
Provider First Name:
EARL
Provider Middle Name:
PEREZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417199969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 7270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92552-7270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-656-1500
Provider Business Mailing Address Fax Number:
951-656-1510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26520 CACTUS AVE
Provider Second Line Business Practice Location Address:
DEPT OF MEDICINE
Provider Business Practice Location Address City Name:
MORENO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92555-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-486-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  A117552 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)