Healthcare Provider Details

I. General information

NPI: 1730736604
Provider Name (Legal Business Name): GABRIELA C ISENIA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E HIGHLAND AVE STE 101
PHOENIX AZ
85014-3609
US

IV. Provider business mailing address

7767 W DEER VALLEY RD STE 140
PEORIA AZ
85382-2103
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-9044
  • Fax: 602-264-0057
Mailing address:
  • Phone: 623-624-7200
  • Fax: 623-624-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: