Provider Demographics
NPI:1730715053
Name:ILAS, TERESITA SORILLA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:SORILLA
Last Name:ILAS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:TERESITA
Other - Middle Name:SORILLA
Other - Last Name:ILAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:78 GREENVALE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1805
Mailing Address - Country:US
Mailing Address - Phone:914-365-0069
Mailing Address - Fax:
Practice Address - Street 1:78 GREENVALE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1805
Practice Address - Country:US
Practice Address - Phone:914-365-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445051-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse