Provider Demographics
NPI:1336205442
Name:ILUORE, AUGUSTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:
Last Name:ILUORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 HAWTHORNE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2323
Mailing Address - Country:US
Mailing Address - Phone:310-219-2929
Mailing Address - Fax:310-219-2940
Practice Address - Street 1:11633 HAWTHORNE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2323
Practice Address - Country:US
Practice Address - Phone:310-219-2929
Practice Address - Fax:310-219-2940
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine