Provider Demographics
NPI:1184783920
Name:BARONE, ILHAM G (MD)
Entity type:Individual
Prefix:DR
First Name:ILHAM
Middle Name:G
Last Name:BARONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4644 LINCOLN BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6374
Mailing Address - Country:US
Mailing Address - Phone:310-306-6966
Mailing Address - Fax:310-306-0667
Practice Address - Street 1:4644 LINCOLN BLVD STE 111
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6374
Practice Address - Country:US
Practice Address - Phone:310-306-6966
Practice Address - Fax:310-306-0667
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG80362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026910Medicaid
CAW8990Medicare ID - Type Unspecified