Provider Demographics
NPI:1336383181
Name:REDRUP, ILEANA ALEJANDRA (BA)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:ALEJANDRA
Last Name:REDRUP
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ILEANA
Other - Middle Name:ALEJANDRA
Other - Last Name:PARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4185 FARQUHAR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3716
Mailing Address - Country:US
Mailing Address - Phone:714-926-5702
Mailing Address - Fax:
Practice Address - Street 1:21810 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator