Provider Demographics
NPI:1356568711
Name:DEFTU, ILEANA CORNELIA (MD)
Entity type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:CORNELIA
Last Name:DEFTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:775-233-7116
Mailing Address - Fax:346-522-3480
Practice Address - Street 1:961 KUENZLI ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1160
Practice Address - Country:US
Practice Address - Phone:775-470-7200
Practice Address - Fax:775-470-7250
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512652Medicaid
NV104321Medicare PIN