Healthcare Provider Details

I. General information

NPI: 1285982009
Provider Name (Legal Business Name): RODNEY C ISAACS SOIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 555341 1ST MARINE SPECIAL OPERATIONS BATTALION
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

BOX 555341 1ST MARINE SPECIAL OPERATIONS BATTALION
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-6588
  • Fax:
Mailing address:
  • Phone: 760-725-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: