Individual provider Active NPI

Joshua Abueg Ilustre, MD

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1770387268
Registry record updated Jul 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
PTL19959 Issued in CA
Practice address
3569 Round Barn Cir Ste 200
Santa Rosa, CA 95403-5784
Phone
(707) 583-8800
NPI assigned
Apr 3, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X PTL19959 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

3569 Round Barn Cir Ste 200
Santa Rosa, CA 95403-5784

Mailing address

1388 Kapiolani Blvd Apt 2204
Honolulu, HI 96814-3656
Phone (808) 218-3635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1770387268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1388 KAPIOLANI BLVD APT 2204",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968143656",
            "telephone_number": "808-218-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3569 ROUND BARN CIR STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035784",
            "telephone_number": "707-583-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILUSTRE",
        "first_name": "JOSHUA",
        "middle_name": "ABUEG",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-03",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PTL19959",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.