Provider Demographics
NPI:1730471699
Name:KATSNELSON, ILANA (MD)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:KATSNELSON
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 1:333 GELLERT BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2690
Mailing Address - Country:US
Mailing Address - Phone:415-361-6212
Mailing Address - Fax:415-480-8443
Practice Address - Street 1:333 GELLERT BLVD STE 119
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2690
Practice Address - Country:US
Practice Address - Phone:415-361-6212
Practice Address - Fax:415-480-8443
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56327208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics