Healthcare Provider Details

I. General information

NPI: 1154254373
Provider Name (Legal Business Name): ISABELLA LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 BOWMAN RD STE 100
AUBURN CA
95603-3197
US

IV. Provider business mailing address

1119 CLELIA CT
PETALUMA CA
94954-5616
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-3951
  • Fax:
Mailing address:
  • Phone: 650-288-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: