Provider Demographics
NPI:1649213653
Name:DE LA LLANA, SYLVIA A (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:A
Last Name:DE LA LLANA
Suffix:
Gender:F
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:PO BOX 3553
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91394-0553
Mailing Address - Country:US
Mailing Address - Phone:818-997-7117
Mailing Address - Fax:818-997-0117
Practice Address - Street 1:14423 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1410
Practice Address - Country:US
Practice Address - Phone:818-997-7117
Practice Address - Fax:818-997-0117
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420110Medicaid
CA00A420110Medicaid
CAA42011Medicare ID - Type Unspecified