Provider Demographics
NPI:1598775538
Name:PAT, ILEANA M (MD)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:M
Last Name:PAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ILEANA
Other - Middle Name:M
Other - Last Name:POSTOLACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:818-355-0555
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69940207RE0101X
WI44021-020207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34344800Medicaid
WI34344800Medicaid
H80639Medicare UPIN
004580054Medicare ID - Type Unspecified