Provider Demographics
NPI:1164862850
Name:ILEJAY, MARIBEL DELOS REYES (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIBEL
Middle Name:DELOS REYES
Last Name:ILEJAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:OBANDO
Other - Last Name:DELOS REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD # 2021
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-907-6478
Mailing Address - Fax:916-734-6564
Practice Address - Street 1:2315 STOCKTON BLVD # 2021
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-907-6478
Practice Address - Fax:916-734-6564
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily