Provider Demographics
NPI:1881001402
Name:ILEANA DEFTU PC
Entity Type:Organization
Organization Name:ILEANA DEFTU PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEFTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-233-7116
Mailing Address - Street 1:PO BOX 50873
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-0873
Mailing Address - Country:US
Mailing Address - Phone:888-707-3335
Mailing Address - Fax:800-707-6449
Practice Address - Street 1:325 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2011
Practice Address - Country:US
Practice Address - Phone:888-707-3335
Practice Address - Fax:800-707-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty