Provider Demographics
NPI:1619133444
Name:AILINANI, HARY R (MD)
Entity Type:Individual
Prefix:
First Name:HARY
Middle Name:R
Last Name:AILINANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 S SAN JACINTO AVE STE A-J
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5103
Mailing Address - Country:US
Mailing Address - Phone:949-783-3600
Mailing Address - Fax:760-406-6073
Practice Address - Street 1:1695 S SAN JACINTO AVE STE A-J
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:949-783-3600
Practice Address - Fax:760-406-6073
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069861A208100000X, 208VP0014X
CAC164092208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201026470Medicaid
INM400050971Medicare PIN