Provider Demographics
NPI:1245958107
Name:ILAOA, JOSEPH EZRA
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EZRA
Last Name:ILAOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971
Mailing Address - Country:US
Mailing Address - Phone:530-283-3330
Mailing Address - Fax:
Practice Address - Street 1:1229 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:RICHVALE
Practice Address - State:CA
Practice Address - Zip Code:95974
Practice Address - Country:US
Practice Address - Phone:530-283-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty