Provider Demographics
NPI:1417259268
Name:ILIA, ELDA (PA)
Entity Type:Individual
Prefix:
First Name:ELDA
Middle Name:
Last Name:ILIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MEDICAL CENTER DR STE 99
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1232
Mailing Address - Country:US
Mailing Address - Phone:909-880-6400
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER DR STE 99
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1232
Practice Address - Country:US
Practice Address - Phone:909-880-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant