Provider Demographics
NPI:1184076333
Name:ILIESCU, ELIZABETH ANN
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:ILIESCU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5996
Mailing Address - Country:US
Mailing Address - Phone:805-682-3585
Mailing Address - Fax:805-682-4072
Practice Address - Street 1:2403 CASTILLO ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5316
Practice Address - Country:US
Practice Address - Phone:805-682-3585
Practice Address - Fax:805-682-4072
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant