Basic Information
| Provider Information | |||||||||
| NPI: | 1396249124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ILYAS | ||||||||
| FirstName: | IRTQA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 MILL ST # W11 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753275174 | ||||||||
| FaxNumber: | 7753275178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 MILL ST # W11 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753275174 | ||||||||
| FaxNumber: | 7753275178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2018 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | DO2922 | NV | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.