Healthcare Provider Details

I. General information

NPI: 1861357014
Provider Name (Legal Business Name): ISABEL REAL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 TELEGRAPH AVE STE 509
BERKELEY CA
94705-1151
US

IV. Provider business mailing address

36012 CABRILLO DR
FREMONT CA
94536-5410
US

V. Phone/Fax

Practice location:
  • Phone: 510-453-4581
  • Fax:
Mailing address:
  • Phone: 510-453-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: