Provider Demographics
NPI:1417287327
Name:ILIE, PAVEL CONSTANTIN (PPS)
Entity Type:Individual
Prefix:MR
First Name:PAVEL
Middle Name:CONSTANTIN
Last Name:ILIE
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 STOVER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1257
Mailing Address - Country:US
Mailing Address - Phone:909-831-9221
Mailing Address - Fax:
Practice Address - Street 1:5745 STOVER AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1257
Practice Address - Country:US
Practice Address - Phone:909-831-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator