Individual
ILIA JBANKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2411 N BROADWAY, LOS ANGELES, CA 90031-2218
(323) 987-2000
(323) 987-1448
Mailing address
6000 N FIGUEROA ST, LOS ANGELES, CA 90042-4232
(323) 254-5291
(323) 254-4618
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP126828
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
95002693
CA
Other
Enumeration date
07/24/2014
Last updated
03/20/2017
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