Provider Demographics
NPI:1700939576
Name:ABRAHAM, ILONA (MD)
Entity type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17815 VENTURA BLVD
Mailing Address - Street 2:SUITE 111-113
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-345-8721
Mailing Address - Fax:818-345-7150
Practice Address - Street 1:17815 VENTURA BLVD
Practice Address - Street 2:#111-113
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-345-8721
Practice Address - Fax:818-345-7150
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25564208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A83256Medicare ID - Type Unspecified
A83256Medicare UPIN