Provider Demographics
NPI:1467635797
Name:ILANGA, ROSELYN DRAPIZA (IDC)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:DRAPIZA
Last Name:ILANGA
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788285
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278-8285
Mailing Address - Country:US
Mailing Address - Phone:760-830-7475
Mailing Address - Fax:760-830-7476
Practice Address - Street 1:MARINE CORPS AIR GROUND COMBAT CENTER
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277
Practice Address - Country:US
Practice Address - Phone:760-830-7475
Practice Address - Fax:760-830-7476
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman