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Organization
MICHAEL J ILAS DO A CALIFORNIA PROFESSIONAL MEDICAL CORP
Active
Organization
MICHAEL J ILAS DO A CALIFORNIA PROFESSIONAL MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J ILAS DO (PROVIDER)
(562) 866-1895
Entity
Organization
Contact information
Practice address
34859 FREDRICK STREET, SUITE 111, WILDOMAR, CA 92595
(562) 866-1895
(562) 866-5730
Mailing address
PO BOX 892577, TEMECULA, CA 92589-2577
(562) 866-1895
(562) 866-5730
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
20A6560
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX65601
—
CA
01
—
20A6560
BLUE SHIELD
CA
Enumeration date
11/01/2006
Last updated
08/22/2020
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