Healthcare Provider Details

I. General information

NPI: 1831776996
Provider Name (Legal Business Name): ISABELLA ANN REPANCOOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 E BELLEVUE RD
ATWATER CA
95301-2300
US

IV. Provider business mailing address

584 E BELLEVUE RD
ATWATER CA
95301-2300
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-2177
  • Fax:
Mailing address:
  • Phone: 559-747-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: