Provider Demographics
NPI:1083927115
Name:ERADAT, JILBERT (MD)
Entity Type:Individual
Prefix:
First Name:JILBERT
Middle Name:
Last Name:ERADAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GILBERT
Other - Middle Name:
Other - Last Name:ERADAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:631 W AVENUE Q
Mailing Address - Street 2:STE A
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10866 WILSHIRE BLVD
Practice Address - Street 2:SUITE 400 - PMB 278
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4300
Practice Address - Country:US
Practice Address - Phone:310-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1079772085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083927115Medicaid
CA00A1079770OtherBCBS OF CA
CACB203332Medicare PIN
CA1083927115Medicaid