Healthcare Provider Details

I. General information

NPI: 1417879958
Provider Name (Legal Business Name): ISABEL SIBLE PHD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

245 BALCLUTHA DR
CORTE MADERA CA
94925-1945
US

IV. Provider business mailing address

454 LAS GALLINAS AVE # 1122
SAN RAFAEL CA
94903-3618
US

V. Phone/Fax

Practice location:
  • Phone: 360-202-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: