NPIMap

Organization Active NPI

Michael J Ilas DO a California Professional Medical Corp

  • Psychiatry Physician
  • Wildomar, CA
National Provider Identifier
1932287620
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A6560 Issued in CA
Legal business name
MICHAEL J ILAS DO A CALIFORNIA PROFESSIONAL MEDICAL CORP
Practice address
34859 Fredrick Street
Suite 111
Wildomar, CA 92595
Phone
(562) 866-1895
Fax
(562) 866-5730
NPI assigned
Nov 1, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael J Ilas, DONPI 1659369445
Title
Provider
Phone
(562) 866-1895

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 20A6560 CA Primary

Addresses

Primary practice location

34859 Fredrick Street
Suite 111
Wildomar, CA 92595

Mailing address

PO Box 892577
Temecula, CA 92589-2577
Phone (562) 866-1895

Other identifiers 2

IdentifierTypeStateIssuer
20A6560OtherCABLUE SHIELD
00AX65601MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932287620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 892577",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925892577",
            "telephone_number": "562-866-1895",
            "fax_number": "562-866-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34859 FREDRICK STREET",
            "address_2": "SUITE 111",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "92595",
            "telephone_number": "562-866-1895",
            "fax_number": "562-866-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J ILAS DO A CALIFORNIA PROFESSIONAL MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ILAS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "562-866-1895",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A6560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "20A6560",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX65601",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.