Basic Information
Provider Information
NPI: 1417199969
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ILANO
FirstName: EARL
MiddleName: PEREZ
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 7270
Address2:  
City: MORENO VALLEY
State: CA
PostalCode: 925527270
CountryCode: US
TelephoneNumber: 9516561500
FaxNumber: 9516561510
Practice Location
Address1: 26520 CACTUS AVE
Address2: DEPT OF MEDICINE
City: MORENO VALLEY
State: CA
PostalCode: 925553927
CountryCode: US
TelephoneNumber: 9514864000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2009
LastUpdateDate: 07/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XA117552CAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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