Provider Demographics
NPI:1578079117
Name:ILEANA PAT INC
Entity Type:Organization
Organization Name:ILEANA PAT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-497-7857
Mailing Address - Street 1:6701 ETON AVE APT 519
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4067
Mailing Address - Country:US
Mailing Address - Phone:818-497-7857
Mailing Address - Fax:818-350-0555
Practice Address - Street 1:19950 RINALDI ST STE 101D
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-497-7857
Practice Address - Fax:818-350-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69940207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty