Basic Information
| Provider Information | |||||||||
| NPI: | 1215959291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYLVESTER | ||||||||
| FirstName: | ILONA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S WELLS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930041377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056591740 | ||||||||
| FaxNumber: | 8056599959 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S WELLS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930041377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056591740 | ||||||||
| FaxNumber: | 8056599959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 03/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A055316 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | RHM18553H | 05 | CA | MEDICAID | RHM08609F | 05 | CA | MEDICAID | 050394 | 01 | CA | BLUE CROSS | OTHER | RHM08608F | 05 | CA | MEDICAID | 95-1683892 | 01 | CA | OTHER INSURANCE | OTHER | ZZT40394F | 05 | CA | MEDICAID |