Provider Demographics
NPI:1104371947
Name:OZERUGA, ILONA (PA-C)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:OZERUGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ILONA
Other - Middle Name:
Other - Last Name:KURDYUMOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6347 COYLE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0438
Mailing Address - Country:US
Mailing Address - Phone:916-967-4278
Mailing Address - Fax:916-967-0367
Practice Address - Street 1:6347 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0438
Practice Address - Country:US
Practice Address - Phone:916-967-4278
Practice Address - Fax:916-967-0367
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant