Provider Demographics
NPI:1659601987
Name:ILAN HARTSTEIN, MD. INC
Entity Type:Organization
Organization Name:ILAN HARTSTEIN, MD. INC
Other - Org Name:ILAN HARTSTEIN, MD. INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-522-4862
Mailing Address - Street 1:7851 WALKER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1747
Mailing Address - Country:US
Mailing Address - Phone:714-522-4862
Mailing Address - Fax:714-522-4293
Practice Address - Street 1:7851 WALKER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1747
Practice Address - Country:US
Practice Address - Phone:714-522-4862
Practice Address - Fax:714-522-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59917207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G0599170Medicaid
CAE50874Medicare UPIN
CAG59917BMedicare PIN
CA4708060001Medicare NSC