Healthcare Provider Details

I. General information

NPI: 1417225244
Provider Name (Legal Business Name): MR. ISAAC JOSEPH FREDERICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HARBOR BLVD BLDG E
BELMONT CA
94002-4018
US

IV. Provider business mailing address

310 HARBOR BLVD BLDG E
BELMONT CA
94002-4018
US

V. Phone/Fax

Practice location:
  • Phone: 650-802-3351
  • Fax: 650-591-3043
Mailing address:
  • Phone: 650-802-3351
  • Fax: 650-591-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberOH35778
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: