Provider Demographics
NPI:1184646283
Name:HARTSTEIN, ILAN (MD)
Entity Type:Individual
Prefix:
First Name:ILAN
Middle Name:
Last Name:HARTSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7851 WALKER ST STE 207
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1746
Mailing Address - Country:US
Mailing Address - Phone:714-522-4862
Mailing Address - Fax:714-522-4293
Practice Address - Street 1:7851 WALKER ST STE 207
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1746
Practice Address - Country:US
Practice Address - Phone:714-522-4862
Practice Address - Fax:714-522-4293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59917207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59917BMedicare PIN
CA4708060001Medicare NSC
CAE50874Medicare UPIN